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Bending the Curve: Boynton Beach based Accountable Care Options Looks to the Future Print E-mail
Written by Jeffrey Herschler   
Tuesday, 08 November 2016 00:00

With 40 member medical practices and slightly more than 12,000 patient lives under management, Boynton Beach based Accountable Care Options ( isn’t the largest Accountable Care Organization (ACO) in Florida, nor does it strive to be. “Certainly that’s one strategy,” concedes Richard Lucibella, MHS, MBA, Director and CEO of the four year old company. “You could try to get real big, real fast with a goal of achieving economies of scale. For us though, it just made sense to grow steadily with quality-focused, like-minded physician partners.”

This strategy appears to be paying off. Three contract years are in the books (2012/2013, 2014 and 2015) and all have resulted in shared savings. “Our PCPs split $7 million in shared savings with the network last year and we are on track for continued success this year,” states Mr. Lucibella. Talk about the Triple Aim among healthcare professionals and you will often be greeted with a cynical look of resignation or perhaps outright derision. Not so with Mr. Lucibella who enthusiastically states that “The Triple Aim is not a pie in the sky goal. We are expanding the definition of medicine to what it should be.” A graduate of University of Pennsylvania’s Wharton School, Mr. Lucibella began his career with the Health Care Financing Administration (Medicare) and was directly involved in the original Medicare HMO risk projects. He has been active in South Florida Medicare risk programs since the mid 1980’s.

As to the future, Mr. Lucibella is quite blunt. “We are aggressively taking on risk. Payer’s don’t want it and most practitioners can’t bear it. But we know how to manage it and profit from it,” he states. Although many primary care doctors fear the good old days are over, the shift to value based care will be a boon to primary care practitioners, according to Mr. Lucibella. “This is revenge of the PCP,” he asserts. Taking additional risk allows Accountable Care Options a SNF waiver, a tele-health waiver and potentially a post acute care waiver. These concessions create resources that can be devoted to expanding chronic care management programs that end up reducing cost in the long run. “If it serves the Triple Aim, the government is going to OK it. This is the smartest CMS we’ve had in thirty years,” states Mr. Lucibella.

Mr. Lucibella is particularly excited about their newly developed ‘Chronic Care Management Program on Steroids’ that targets the 5% of their patient population at highest risk. The full arsenal of resources, including physicians, NPs/PAs, nurses, MAs, behavioral health professionals, pharmacists (through a partnership with Nova Southeastern University), paramedics, palliative care professionals and (soon) nutritionists, is deployed. 

With skepticism rampant in today’s health industry I had to ask Mr. Lucibella if he really believed we could bend the cost curve. “Absolutely,” was his immediate reply. “We are also going to bend the quality curve.”

EDITOR’S NOTE: We first interviewed Mr. Lucibella in  2014. You can read that article HERE>>

Last Updated on Wednesday, 09 November 2016 11:14
What's the one word cancer patients don't want to hear? Print E-mail
Written by Don Dizon, MD | KevinMD   
Tuesday, 01 November 2016 11:51

She had come to see me in consultation. A professor at a local university, she was well until four years earlier when she developed abdominal bloating and pain - telltale signs of ovarian cancer. Surgery followed, then adjuvant chemotherapy with intraperitoneal treatments. ("Terrible regimen," she said.) She was fine for two years, until the bloating recurred heralding recurrent disease. Surgery followed and she sought out a second opinion about more therapy. "My oncologist recommended more of the same - carboplatin and paclitaxel. But it didn't cure me the last time, so it doesn't make sense to me that this would be the best treatment for me now. I wanted to know what else was out there," she told me.

We talked about well-established concepts in the approach to recurrent ovarian cancer, such as platinum sensitivity, and how that predicts success to retreatment with carboplatin. I explained why I thought her doctors were right in their suggested treatments, and reviewed other platinum-based combinations she could receive. We also reviewed clinical trials and novel treatments, such as bevacizumab.

Read More>>

Last Updated on Tuesday, 01 November 2016 11:52
Spike in heroin overdoses treated at Jackson Memorial prompts pilot rehab program Print E-mail
Written by FHI's Week in Review   
Monday, 24 October 2016 16:00

In a 10/19/16 Miami Herald post by Daniel Chang (Login/Registration may be required):
Over the past three years, physicians at Jackson Memorial Hospital's emergency room have seen a dramatic spike in patients who overdose on a combination of heroin and the synthetic drug, fentanyl...

The deaths related to fentanyl and similar synthetic drugs have also overwhelmed toxicologists at the Miami-Dade Medical Examiner's Office.
So far in 2016, those drugs have been tentatively identified in 180 overdose victims in Miami-Dade - with 52 in September alone, according to the office. That's nearly double the number of cases from 2015.

Read more in the current issue of Week in Review>>

Last Updated on Friday, 11 November 2016 18:39
OIG report finds claims filed on behalf of the dead Print E-mail
Written by Vitale Health Law   
Tuesday, 18 October 2016 18:54

With Halloween just around the corner the HHS' Office of the Inspector General just released a report showing that during a two-year period The Centers for Medicare & Medicaid Services (CMS) paid out nearly half a million dollars for claims made on dead people.

Federal law requires CMS to establish policies and implement claim edits to ensure that payments are not made for Medicare services ostensibly rendered to deceased individuals. However, in its most recent report, the watchdog agency identified $426,000 in "improper payments for 427 Medicare claims" between 2013 and 2015 related to claims for the deceased. It identified another $1.48 million in potentially improper payments for 1,047 Medicare claims with dates of service that were after the individuals' dates of death.

These "zombie claims" if you will, are nothing new. In 2013, the OIG found that Medicare had paid out $23 million in benefits in 2011, for 17,403 people who were dead. In 2014, the OIG issued another report that found CMS had paid nearly $300,000 for HIV drugs for dead people.

Health and Wellness Marketplace for Cash Paying Patients Print E-mail
Written by Jeffrey Herschler   
Wednesday, 12 October 2016 13:40

Q & A with Alain Fernandez, ValueDOC
Editor's Note:
ValueDOC is a free health and wellness marketplace for cash-paying patients. Founder Alain Fernandez launched the website earlier this year with a couple of hundred doctors and dentists featured. ValueDOC won the Miami Herald Business Plan Challenge’s FIU Track in May. I had a chance to catch up with Alain earlier this week. Below is a transcript of our chat.

JH        In an earlier conversation you said ValueDOC is filling a void in the current healthcare marketplace. You also talked about delivering transparency and efficiency. Can you explain what you meant by that?

AF           Unfortunately, in today’s healthcare environment the self-pay patient, whether they carry no insurance or a high-deductible plan, is not able to go to one place and shop for the most basic medical or dental service, like you would if you were booking a hotel or vacation.  At, self-pay patients can book online appointments with local, pre-screened doctors and dentists and access substantial discounts by simply using their debit or credit card. Doctors on our platform offer the most common medical, dental and wellness services, such as dental cleanings, mammogram, doctor visits, acupuncture, skin care, vision, labs, etc., in exchange for pre-payment. Patients are able to sort by price, distance, or online reviews. The entire process is both efficient and completely transparent.
JH        Reporter Nancy Dahlberg, in the May Miami Herald feature, referred to ValueDOC's aim to make booking a doctor as easy as ordering an Uber. What did she mean by that?

AF           I believe she was referring to how simple the process is, and how, like Uber, we are using technology and good design to completely change the patient experience.
JH        So what’s in it for the physician or dentist? Why would he/she want to join your network?

AF           It’s absolutely FREE for a doctor or dentist to join our platform. They simply need to create a professional profile, which can take less than ten minutes to complete online. The doctors and dentists in return get exposure to our cash marketplace, and getting paid for the visit within two business days of booking — maybe even before the service is rendered — is very appealing when many can wait months to get paid from insurances. Some doctors have lull times where they can accept pre-paying cash payments. Others may be building their practice so exposure to this marketplace can save them time and money on marketing. Like the Uber model, ValueDOC keeps a small portion per booking.
JH        I imagine a lot of healthy under 30 people, without access to employer coverage, would take the catastrophic plan on the exchange, fund a health savings account and sign up for ValueDOC. In fact, healthy Americans of any age (under 65), facing double digit rate increases, might be tempted to opt out of the exchange, pay the penalty and join ValueDoc. So it’s conceivable health insurers would lose business to ValueDOC. Do traditional payers view you as a threat?

AF           I don’t think so. Traditional payers have a place in the market. For the most part, health insurance is there to cover patients when their health turns for the worse.  ValueDOC is an affordable solution for a patient’s most basic medical and dental needs. I see ValueDOC as a supplemental offering patients can use for their everyday care, but can turn to their catastrophic plan if they need to go to the hospital.

JH        Trump would repeal and replace Obamacare. Meanwhile, Clinton would expand it, possibly by adding a public option. Regardless of your personal politics, it seems a Trump presidency would be better for the ValueDOC business plan. Have you given any thought to the upcoming elections and the possible impact on ValueDOC?

AF           Being involved in the healthcare sector for close to 25 years, I’m always thinking about healthcare. I don’t think that either candidate will change the fact that in the last decade patients’ out-of-pocket costs have more than doubled, and the number one reason patients don’t go to the doctor is cost. The trend of shifting cost towards the patient will continue with either president. Both candidates have noticed this trend and each have their own proposal on how to deal with it. Clinton wants a new tax credit to offset deductibles, while Trump wants to expand health savings accounts. What they both agree on is that patient consumerism and transparency is here to stay, and this is where ValueDOC is positioned to help doctors and patients alike.

Last Updated on Monday, 31 October 2016 18:18
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