Taking the risk

Re: "Accountable Care and Shared Risk: Where Do We Stand?" by Paul Keckley in H&HN Daily, Dec. 2

Paul: I believe you have a good handle on the topic. I would like to offer some real-life experiences in support of your observations. I have put together accountable care organizations for insurance companies and providers. First, you can't treat every population the same. Medicare is different from Medicaid and both are different from commercial. You must have a different set of providers willing to work with their respective populations to achieve efficiency. In order for hospitals to take risk, the physicians must be on board. If physicians of an ACO are treating in a fee-for-service environment while the hospital is at risk, it won't last long. Many hospitals have chosen to put the physicians on payroll instead of trying to work with them in a risk environment. This is one solution, but there are drawbacks. It can work if the incentives are aligned properly. One market I worked in, the physicians subcontracted the hospital under their risk contract. It worked well.

Ken Stephenson

The Link Is Clear

Re: "Mind + Matter = Health Care's New Math" by John Morrissey, December H&HN

The article about mental health parity explained why there is a strong relationship between psychological issues and a person's physical health. Even people who do not have severe depression can certainly relate. Don't you feel physically out of sorts when you are even a little blue? Imagine what it is like when you are extremely depressed. Of course, substance abusers are bound to have physical problems, and are apt to ignore their advice from doctors and nurses. Why has it taken this long for the rest of the world to catch up to the health care world in recognizing this clear relationship?

Kathleen Lambert

Hopeful about Sepsis

Re: "Reducing Mortality from Sepsis" by Todd L. Allen, M.D., in H&HN Daily, Nov. 14

Efforts over the past few decades seem to have waned now and again, although I wholeheartedly believe there will be no future lapse in attention or research. As more hospitals in more countries use sepsis bundles, such as those implemented by Intermountain Healthcare's Intensive Medicine Clinical Program, the horizon is bright with further reduction of mortality rates.

Paige Ward

Lessons from Everywhere

Re: "Fostering High-Speed Innovation in Health Care" by Dan Beckham in H&HN Daily Dec. 12

Excellent article and insight! Deming's System of Profound Knowledge has intrigued me for quite some time, and I love enlightening fellow Army medical professionals regarding his ties to WWII, Japan and Ford. No matter the model used, given good data, effective leadership is the key to successful process improvement. Being strong and insightful enough to reach out to other industries will provide health care leaders with a wealth of knowledge and experience that we cannot afford to overlook.


The Obesity Obstacle

Re: "Living to 100, But Feeling Like 50" by Bill Santamour in H&HN Daily, Nov. 5

I love the idea but until we get the obesity rates under control, this will only remain an idea. Obesity has surpassed smoking as the No. 1 cause of preventable death in the United States.

Julie Chicoine

Ever Vigilant

Re: N.Y. Quality Improvement Organization in "Making a Dent in Curbing Readmissions" by Marty Stempniak in H&HN Daily, Dec. 16

Thank you for an astute article. As in many fields, in biomedical research the weekly meetings with the right people (the process improvement and research team) is a basic practice for vigilant management of the research protocol. Yet, this issue has been overlooked by many in the research field.

David R. Van Houten