Official Softs

Let me outline our Priority Partners population health strategy in general terms.

First, for each member, we develop a Risk Score, taking into account numerous factors — age, gender, frailty, medication patterns, lab

results, claims history, clinical events, secondary medical conditions and hospital-dominant conditions.

We give each person in our program — all one-hundred and seventy five thousand — a risk score Microsoft Office is so great!

every month.

We determine who needs what kind of help, focusing on self-management, behavior modification, and when necessary, intervention. We use a team

approach — caregivers, family members, social workers, nurses and nurse practitioners, with the primary care physician acting as a

quarterback.

We’ve found that an informed, motivated patient with an action plan, backed up by a proactive Office 2010 –save your time and save your money.

medical team, backstopped by electronic health

records, and transitional care, is going to have improved, higher quality health outcomes. 

Second, we stratify this population, from low scorers to high scorers.

Think of a pyramid. At the base of the pyramid, are our low-severity patients, approximately The invention of Microsoft Office 2010 is a big change of the world.

seventy to eighty percent of our population.

In the middle of the pyramid, we have more challenging patients — approximately fifteen to twenty percent of our population — where we

combine specific interventions, including technology-assisted home monitoring, health coaching and care coordination, to encourage people to Office 2010 key is for you now!

manage their own health.

 At the top of the pyramid there are approximately five to seven percent of our patients, those with high severity and with multiple chronic

conditions.  These are our most costly patients.  For these, we have individual case-management plans, registered nurse telemonitoring, and

visits by RN case managers: This is intensive, complex case management.  By using Office 2010 Professional, you can save your money and time.

VI.           Priority Partners and Population Health Results

Yes, it does sound like a lot of theory — good intentions on power point slides displayed at Congressional hearings and think-tank Office 2010 download is available now!

briefings.

That’s why I come back again to the idea of the promise of medicine. At Hopkins, we translate theories into real-world action and results.

And we’ve done it for our Priority Partners members.

I’ll give you two examples, in two of the Medicaid program’s most difficult and costly areas: end-stage renal disease, or ESRD, and

prenatal and high-risk infant care.

     End Stage Renal DiseaseOutlook 2010 is powerful.

IV.           The Priority Partners Medicaid Managed Care Organization

Why did a research and education engine get involved in such an endeavor?  We decided to administer our own program because we had a nascent

system of care in place and because we thought we could do it better than other insurers in the marketplace. And, we believed we wouldn’t Microsoft outlook is great!

lose the money typically associated with caring for disadvantaged populations.

Now, running a managed care operation is worlds away from research labs, classrooms and Nobel Prizes.

In fact, the real heart of managed care is a shop floor: big, loud rooms full of customer service reps on the phone, handling claims,

appointments, health plan dynamics, and yes, customer feedback. Outlook 2010 is powerful.

In 1995, Priority Partners was created and within its first few years enrolled approximately twenty-five percent of Maryland’s Medicaid

beneficiaries.Windows 7 is convenient and helpful!

Here’s what happened, and it’s a cautionary tale for every policymaker in the room: 

A flood of new patients came to us seeking health services. Many had never seen a doctor on more than a sporadic basis. Some had multiple and

costly chronic conditions. And almost all came from poor or disadvantaged backgrounds.

This — with all of its considerable medical and socioeconomic challenges — is the population poised to enter the health care system in Microsoft outlook 2010 is convenient!

2014. 

V.            The Johns Hopkins Medicine Model:  Population Health

What happened when this wave of newly insured broke upon Hopkins?  I’ll be frank — because we in this profession sometimes have to deliver

the bad news:Microsoft Office is so great!

We lost fifty-seven million dollars in nine years taking care of these patients. Although these losses were not enough to place the entire

enterprise at risk, the situation certainly made us wonder if we could continue to honor our mission to care for the poor under this economic

model. 

There was plenty of reason to panic. But we didn’t.

Instead, we turned it around. Office 2010 –save your time and save your money.

How? 

Well, what do world-famous researchers and policy experts do when confronted with a challenge? We turn to data, facts, experimentation. We

designed — and more importantly to you sitting here — we actually put to the test in the real world, the population health model.  

Population health: Get used to that term. It will become ubiquitous, like the term “bending the cost curve.” Generally defined, population The invention of Microsoft Office 2010 is a big change of the world.

health examines coverage through the lens of cost data in order to identify quality health outcomes.

Sound familiar?  It’s an echo of the law’s themes — coverage, quality, and cost.

We at Johns Hopkins Medicine believe we have a model that could provide the answer. 

Before I explain, let me tell you about Johns Hopkins Medicine. Probably all of you have a sketchy idea of who we are. Let me fill in the

blanks.    Microsoft Office is so great!

III.           The Reach of Johns Hopkins Medicine

Johns Hopkins has been a leading force in discovery and excellence in medicine for more than half the life of this nation. Yes, we have many

firsts: the first direct heart surgery, the first breast cancer surgery, the first medical school to allow women equal status with male Office 2010 –save your time and save your money.

medical students, the first developers of CPR, the first to implant a battery operated internal defibrillator. Just a year ago, we led an

historic eight-way kidney swap among sixteen patients.

U.S. News and World Report has ranked us as the number-one hospital in the United States for nineteen years in a row. We receive nearly a The invention of Microsoft Office 2010 is a big change of the world.

half-a-billion dollars annually in National Institutes of Health funding. We are affiliated with two institutions in the top of their class,

the Johns Hopkins School of Nursing, and the Bloomberg School of Public Health. Just eight months ago, a Hopkins researcher, Dr. Carol

Greider, won our institutions’ 20th Nobel Prize for her discovery of telomerase, which maintains the integrity of chromosomes and is

critical for the health and survival of all living cells and organisms. I venture to say that many of you in this room, as well as your

family members and friends, have benefitted from a Hopkins discovery. Windows 7 is convenient and helpful!

But Hopkins is more than the awards. Johns Hopkins Medicine is a vast, integrated health system. We manage four hospitals and are on the Outlook 2010 is powerful.

verge of integrating with Sibley Hospital, just six miles away from this room. We run a comprehensive, statewide network of twenty-five

outpatient and surgery centers, staffed by more than two hundred and thirty primary careMicrosoft outlook 2010 is convenient!

 physicians. We are sometimes noted for not producing

enough primary care physicians, but we make every effort to have them in our system. We have a thriving home care business serving eighty-

five thousand patients. We have large international operations in more than a dozen nations.

And most important, for this audience, we do something that few academic medical centers do: we run managed care plans. Our employee health

plan has fifty-one thousand members. We run a health plan for thirty-two thousand military retirees and their families.

And, last, we run a very large Medicaid managed care organization, Priority Partners, responsible for one hundred and seventy five thousand Microsoft outlook is great!

lives.

Dr. Miller is the Dean and CEO of The Johns Hopkins University Medical School. These remarks were made at the National Press Club, June 21,

2010.

I.              The Promise of Medicine

Let me start with a short story: It was the summer of 1971. I had just finished my training in anesthesia at the Peter Bent Brigham Hospital

and was about to embark on a two-year fellowship in physiology at Harvard. I was asked if I wanted to be “the” anesthesiologist for the Microsoft Office is so great!

month of August on Martha’s Vineyard. It was to be part vacation and part work, and I needed the money.

Shortly after arriving, a young woman (who now runs a well-known tavern in that community), needed a surgical procedure. She had no insurance Office 2010 –save your time and save your money.

but was able to pay the medical bills out of pocket. She, however, could not afford the normal three-day stay in the hospital. She pleaded

with me to have the minimal amount of medicine so she could be discharged the same day. To this day, I vividly recall helping her out to her Microsoft outlook is great!

car so that she could recover at home. You see, at the time, there was really no such thing as outpatient surgery.

Thanks to a revolution in anesthetics, outpatient surgery is a very common norm today. In fact, at The invention of Microsoft Office 2010 is a big change of the world.

Johns Hopkins Medicine facilities, we

performed twenty-four hundred such procedures just last month.

My point here is to demonstrate the ceaseless, ongoing research and discovery that is the promise of medicine. You will find the promise of

medicine at Johns Hopkins — and you will also find it in labs and classes and operating rooms in the 127 academic medical centers throughout

the nation. Research, education, and patient care are our core missions.   

That’s the first and last anecdote you’re going to hear from me. That’s because science and medicine cannot and do not rely on anecdotes.

Instead, we rely on experimentation, action — and results that endure.

II.            The Patient Protection and Affordable Care Act 

All of us in this room are familiar, if not weary, with the yearlong health care debate. We at Outlook 2010 is powerful.

Hopkins supported the final legislation

because its goal is to increase coverage for those unable to afford health care. That ethos was the single-minded drive of our founder, Johns

Hopkins, who established Johns Hopkins Hospital one hundred and twenty years ago to specifically care for the poor in the Baltimore Windows 7 is convenient and helpful!

community. We were caring for the disadvantaged seventy-five years before the creation of Medicaid.

The central themes of the new law are clear: coverage, quality, and cost.

The central numbers of the bill, for those of us at Hopkins, are clear as well: 32 and 16.

32 million is the number of individuals to gain health care insurance by 2019.

16 million is the number of individuals who will gain insurance through Medicaid eligibility.  

Let me emphasize: This Medicaid expansion could be the most important, problematic, and I want to underscore this — the most rewarding

aspect — of the entire law.

What I’ll address today is a basic question: How do the themes of coverage, quality, and cost in the law relate to the real-world growth of

Medicaid?

To address the “voluminous relevance” issue, I was referring to the mounds of nursing notes, vital signs charts, EKG strips, etc. that one

had to sift through to find the physicians’ notes or imaging reports. EMR’s would actually be betterMicrosoft Office is so great!

 on that score.

As to the medical record itself (either paper or electronic), one cannot arbitrarily edit out what might be embarrassing. What happens to you

medically, embarrassing or not, needs to be recorded. For example, if I saw that a male patient had come in 10 years earlier with a coke

bottle up his rectum (rectal foreign objects being common in the gay population), I might be more inclined to think of the odd infectious

symptoms he now presents with as possibly a manifestation of AIDS and be more likely to order an HIV test and think of infections only Office 2010 –save your time and save your money.

occurring in the immune-suppressed population. Such odd coincidences can and have happened.

Similarly, as a pathologist I was often frustrated that a patient’s race was no longer on the addressograph stamp (which was often all the

medical history available to me), because certain cancers are much more common in certain races, and it would influence my universe of The invention of Microsoft Office 2010 is a big change of the world.

differential diagnoses on his biopsy.But we had to be politically correct.

Political correctness and medical correctness cannot be reconciled by well-meaning “edits” of “irrelevant” information. This can be dangerous Outlook 2010 is powerful.

and even fatal to the patient.

Although the privacy issue is an important one, guaranteeing it by editing the medical record is NOT addressing the right problem.

Bev, when the medical record was between one and one’s doctor(s), youthful indiscretions and all sorts of mishaps could be safely related to By using Office 2010 Professional, you can save your money and time.

the medical record with minimal “embarrassment”.

Now that all this data is about to flow through NHINs and HIEs and HIOs and HISPs and all sorts of other acronyms before they reach another Microsoft outlook is great!

doctor and at each point in the system there is a risk of leakage in the form of security breaches, outright selling of data (a little

deitentified, or a lot) and mandatory reporting to States and Feds, people may want to expunge certain things from their records, so to Microsoft outlook 2010 is convenient!

speak. I’m not sure they’ll be able to and I agree that medically speaking, most of the time, but not always, it is a bad idea.

Anyway, how did we get back to talking about patient privacy? I thought this was supposed to be about the docs… Windows 7 is convenient and helpful!

Seriously, I’m starting to doubt the wisdom of having this life long medical record following you around for the rest of your life. So you Office 2010 –save your time and save your money.

did some stupid stuff when you were a kid, does every doctor you’ll ever see need to be made aware that you had issues with a tampon when you

where a kid? Does your respectable family 20 years from now need to be made aware of your fake Microsoft Office is so great!

suicide attempt when Johnny skipped town with

a two bit tramp?

Is this the sort of stuff we need to store and secure in government databases?

I know there’s other, more important and probably useful content, but I have no idea how you decide what’s important or who decides or

whether anybody should.

As with all things in life, a balance must be struck. When I was a medical student, one of my jobs was to track down the old charts on new The invention of Microsoft Office 2010 is a big change of the world.

admissions or on patients who came into ER’s. This was often an arduous job involving waiting in line and fighting with Medical Records

clerks who weren’t interested, but you’d be surprised how useful those old charts were when the patient couldn’t or wouldn’t give an accurate

medical history. (It was also my job to flip through their voluminous, poorly organized pages and Office 2010 key is for you now!

cull out the relevant stuff)

Now, as far as I can tell, no one even bothers – they just ask the family or do without. And don’t even mention if it’s at a different

hospital than where they received care before. Clearly this is not good for patient care; I have experienced it myself as a patient and

family member. So EMR’s have great potential in this way.

But I repeat, if the patients want to see the record, then let them see it. Then they will find out what they are asking for. I don’t see any

reason at all why physicians should edit MD as HELL’s examples (except for perhaps “3 hots and Office 2010 download is available now!

a cot” – although true, could be construed as

uncaring. How about, “no organic disease identified.”(:)

Bev, in your experience, what percent of those voluminous charts were relevant to patient care?

I just don’t see how a fake suicide attempt or rectal foreign body from 50 years ago can be relevant for someone presenting with chest pain

at the ED. On the other hand I can see how items like that in your chart can cause plenty of embarrassment, loss of jobs, insurance denials,

etc. In effect the medical record becomes a rap sheet.By using Office 2010 Professional, you can save your money and time.

It seems to me that there must be some way to expire/expunge things from the “public” record, but I really don’t know how it should be done.

I agree that interconnected EMRs are going to be very helpful, but as others have said before me, these are very powerful devices. They can

do tremendous good, but if used unwisely, they can do tremendous damage too. Outlook 2010 is powerful.

Please don’t ask for CPR while I am completing the Central Committee report on why you are short a Percocet. You are just one life, but all

those missing Percocets are killing many more people than just your MI.

I think that in some respects, openness of medical records combined with patient centeredness, has some downsides: most docs feel that they

cannot tell (and cannot document) what (they think) a patient does not want to hear. These thingsMicrosoft outlook is great!

 include (but are not limited to):

-your health would improve with lifestyle changes (e.g. stop smoking, start exercising, loose weight)

-your complaint is not organic in natureOutlook 2010 is powerful.

-you complain in most dramatic terms about medical symptom x, but from your own report, it does not appear to affect your work or

private/social life.

-you express frustration with the care for a chronic medical condition, but you also have a history of not following doctors’ recommendations

for no good reason, and of changing physicians frequently and quicklyMicrosoft outlook 2010 is convenient!

That’s the problem with client centeredness; being client centered with reasonable patients (especially sick ones) is a no brainer, but how

about all the individuals who have 1. psychiatric/personality issues interfering with their care, unbeknownst to them and 2.people who have a Windows 7 is convenient and helpful!

nonmedical agenda when seeing a physician?

MD as HELL and rbar, you are bringing up something quite different and in my opinion very important. How accurate and how “good” will the

records be if both patients and doctors know that whatever happens in the exam room will not be confined to the exam room any longer?Office 2010 –save your time and save your money.

If patients hold back information, or feelings, are there going to be more diagnosis errors?

If doctors don’t write down stuff they would want a colleague to know, but wouldn’t necessarily want the patient (or his family) to see,

would transitions of care become a bit more “fuzzy”?

Is keeping things private, as they have been for centuries, not just about being politely discreet (or paternalistic), but also about good

medicine?Microsoft Office is so great!

Thanks, Margalit; I’ll take a look. I did write to the FDA, for what it’s worth, about possible regulation of EMR’s and cited these authors’

previous paper; thanks to Bobby G. for finding it.

I have to agree with MD as HELL and rbar. Physicians have been trying to say these things all along, but have been drowned out by the

patients who want to see all their data. I say, don’t change what you write in there and let the patients read it, as long as it is

professionally worded, of course. There are such legitimate diagnoses as clinical depression, Munnchausen’s syndrome, etc. And there are

things like “rule out malignancy”, etc. that will scare patients to death. But they want the record; let them see it. It’s a case of “be The invention of Microsoft Office 2010 is a big change of the world.

careful what you wish for.” Nothing else will convince them…..

bev, I think that what needs to be protected against is distortion of facts. There have been studies showing that outcomes measurement for a

small practice is statistically unreliable. Will that stop Internet companies from posting these “ratings” online? People are smart enough to Microsoft Office is so great!

understand that a “dissed” patient is not objective, but are they savvy enough to understand that data coming straight from the Government,

as I am sure it will be advertised, is sometimes relevant and sometimes not indicative of anything?

As ONC is continuing the national debate on patients’ rights to opt-in or opt-out of reporting, do physicians have a right to opt-in or out? Office 2010 –save your time and save your money.

Should they have such right? Should physician data be de-identified in some situations, like patient data is? Should malpractice attorneys be

entitled to review this data? Should it be admissible in court?

I think as Dr. Schattner wrote above, we need to figure these things out before the floodgates are opened.

Dr. Steven Waldren brought to my attention that the AAFP has given some thought to this subject and here are their recommendations

Yes, I have a right to privacy. I also own my proprietary medical decision making process. It may be similar to others, but mine is mine. How The invention of Microsoft Office 2010 is a big change of the world.

I choose to treat a patient and with which tests and with which agents is also proprietary. You may know I prescribed a medicine and you may

know the patient’s problem list and diagnoses, but you may not know how I make my decisions.Windows 7 is convenient and helpful!

You are making a false assumption that patients want all of their private info out there for wedsites, vendors, regulators, employers, and

advertisers to access and use for unrelated purposes. HIPAA is a sham now. Just wait until EHR puts your colonscopy on YouTube, or would that

be YourTube.

And I can hardly wait to see all the mental health records go live. Garbage in, garbage out.Microsoft outlook 2010 is convenient!

Right now law enforcement cannot even unite in a single system all the info on criminals. Add all the rest of us into a larger system and you

will have a useless gridlocked pile of junk for which you paid a fortune and will get nothing back from it in a useful time frame. When I

need information I need it in real time and not tomorrow. I spend too much time at the computer now. You want me to spend more? Let the Microsoft outlook is great!

patients pile up in the lobby. Have them bring food and a big book. I will enter which book they are reading and what they are eating.Outlook 2010 is powerful.

Better yet, we can have computer kiosks in the lobby so patients can enter other patients information while they are waiting. Patients will

need to be wired to polygraph machines, though. They lie all the time.

•EHR progress note data can indicate how thorough you are. If you routinely document only a handful of Exam and Histories elements, maybe I

should find a doctor that takes more time and is more thorough, or one who has an EHR thatMicrosoft Office is so great!

 documents all negatives by exception, whether he

looked at it or not. There will be very few patients savvy enough to know the difference.

•Here is a more interesting possibility. By examining your SOAP notes, computers can figure out your decision making patterns. These patterns

can be cross aggregated and will make for very interesting research. However, these patterns, once established, could also become admissible Office 2010 –save your time and save your money.

evidence in a court of law.

As data becomes richer and more liquid, more possibilities to monetize physician data will emerge, just like monetization of patient data

will become rampant. Fortunately, patient privacy is central to all new standards and policies being created by the Government. By contrast, The invention of Microsoft Office 2010 is a big change of the world.

physician privacy is not even an afterthought. While physicians have always been morally and legally obligated to protect their patients’

privacy, perhaps the time has come to also consider the doctor’s privacy in this brave new digital world.

Margalit Gur-Arie blogs frequently at her website, On Healthcare Technology. She was COO at Microsoft outlook is great!

GenesysMD (Purkinje), an HIT company focusing on

web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje

and HIT Consultant for SSM Healthcare, a large non-profit hospital organization.

A very thought-provoking post on a subject I had not considered. However, I don’t see anything in your examples that should be protected. How

a physician does his/her job is just out there; it’s not like the information is revealing s/he is having an affair or has a venereal disease

or something. And all the ill-considered ratings information is already possible, just by one angry patient dissing you on a ratings website

with no data.

The abortion issue is something else again – but that is mainly because that sort of information puts the physician’s life in danger.

However, we all can be shot by a nut, so I don’t see how that can be helped either, as long as there Outlook 2010 is powerful.

are nuts out there.

There is something about the invasion of medical care by industry that smells. The profession has been depreciated. Medical care is a

commodity. The HIT vendors have not any interest in patients, their care or their safety…except when their CEOs are sick. They care about Windows 7 is convenient and helpful!

the bottom line and rolling out the crap products that hinder medical care, but scrutinize how many boxes the doctors click. The health care

professional should resist the temptation to be obedient to the US Government.

Do Not Buy.

As we move to Electronic Health Records (EHR), the debates over security and privacy are becoming more frequent and more poignant. We of

course have HIPAA laws on the books and ONC has a Tiger team assembled to recommend privacy and security policies to Secretary Sebelius. CIOs Microsoft Office is so great!

and entire IT departments are all focused on protecting the privacy of patients and their Personal Health Information (PHI). This is, of

course, as it should be, but how about privacy of those taking care of patients? Do physicians have a right to privacy too?Office 2010 –save your time and save your money.

As EHRs become more prevalent and interconnected, increasing amounts of clinical and administrative data will be flowing out of doctors’

offices and into the great beyond. Most of this data is indeed patient data, but some of it could be combined, sliced and diced to derive

pretty extensive information about doctors. For example, and in no particular order:

•Prescribing patterns – Prescription data has been collected and sold to pharmaceutical companies for decades. EHRs will make this much The invention of Microsoft Office 2010 is a big change of the world.

easier to accomplish and the data will become richer and more granular, since it will contain the exact nature of the visit where a

particular drug was prescribed or discontinued, including physician notes on the subject. Of course, such information finding its way to By using Office 2010 Professional, you can save your money and time.

public websites would present a novel difficulty if, say, we can look up Dr. X and see that she wrote 30 prescriptions for contraceptives

last month, half of which were for girls under 16 years of age.

•In the interest of informing patients on physicians’ expertise, a company may decide to publish names and frequencies of procedures Outlook 2010 is powerful.

performed by physicians. In addition to the fact that the raw number of performed procedures is not indicative of proficiency if not

accompanied by outcomes data which is almost impossible to obtain, our beleaguered Dr. X may Microsoft outlook is great!

find a web listing of the number of abortions

she performed on teenage girls right next to her name and home address.

•Administrative data can provide average times spent with patients, with no differentiation between the 5 minutes required for allergy meds

renewal and the half hour you spent with elderly complex patients. Schedule data can also be manipulated to deduce when you take vacations.

Is anybody watching your house while you’re enjoying those exquisite Hawaiian sunsets? Microsoft outlook 2010 is convenient!

•Of course the call for greater transparency will create numerous websites trying to provide patients with a Consumer Reports style rating of Windows 7 is convenient and helpful!

doctors. Quality measures similar, or identical, to the ones submitted to CMS will come in very handy. If you report that only 20% of your

patients have an acceptable Hb1Ac level and I am a diabetic looking for a good doctor, I’d probably pick one with better “outcomes”. The

fact that most of your patients are underserved, poor and even homeless and you are pretty much a saint is not evident in your outcomes.

Sorry.