The tech giant is looking to the former exec for guidance on addressing healthcare improvement in a way that could reduce burden on providers.

Toby Cosgrove, MD, the Cleveland Clinic’s former top executive, will share a stage Tuesday afternoon with several colleagues from his new employer: Google.

Cosgrove, who served as the clinic’s CEO from 2004 through 2017, signed on as an executive advisor to the Google Cloud Healthcare and Life Sciences team, the company announced in a blog post last week. An update to his LinkedIn profile indicates he’s been in the role since January.

As part of his new role, Cosgrove will join National Institutes of Health Chief Information Officer Andrea Norris for a conversation Tuesday about how advances in cloud computing are changing healthcare.

Those advances can help stakeholders go beyond achieving the triple-aim of healthcare improvement—better patient experience, improved population health, and reduced cost—to add a fourth aim, according to Gregory J. Moore, MD, PhD, vice president of healthcare for Google Cloud, who will moderate the conversation.

Although advances in technology have added to the recordkeeping burden on healthcare workers, people like Cosgrove can help companies like Google improve the work experience of physicians and their staff, Moore wrote in the blog post.

“Technology may have been the cause of some of these challenges, but we believe that it can also be the cure,” Moore wrote.

Cosgrove, who retired from Cleveland Clinic in January, also joined the board of Denver-based healthcare IT company RxRevu, as HealthLeaders Media reported last month.

Cosgrove’s successor, Tomislav “Tom” Mihaljevic, MD, has been the clinic’s CEO since January.


Anthem Now Requiring Pre-approval for Hospital MRIs, CT Scans

Image result for medical necessity

The insurer no longer allows outpatient imaging in hospitals. Hospitals may feel the financial loss.

In a bid to cut costs, Anthem is now informing consumers that it must pre-approve any hospital-based MRIs and CT-scans, and that approval won’t come easily.

The insurer’s new policy forbids hospital imaging services on an outpatient basis and requires proof that inpatient imaging is medically necessary.

The Anthem change in policy is likely to be a financial blow to hospitals, which have seen outpatient imaging as a profit center in recent years.

Anthem announced recently that outpatient MRIs and CT scans must be performed at lower-priced facilities, citing its commitment to the Institute for Healthcare Improvement (IHI) Triple Aim Initiative, which calls for improving the patient experience, improving population health, and reducing costs.

The insurer says clinical research has shown the safety of imaging services in free-standing facilities, so the additional cost of a hospital setting is unnecessary.

“Anthem’s primary concern is to provide access to quality and safe healthcare for our members. We are also committed to reducing overall medical cost where possible when the safety of the member is not put at risk,” the company says.

Anthem notes that imaging costs can vary widely without any effect on quality of care, with scans costing as little as $350 and as much as $2,000.

The company also notified providers of the change in policy, explaining that physicians must obtain pre-certification approval for inpatient hospital imaging. Anthem told consumers that it will provide assistance in finding imaging facilities other than hospitals.

The change in policy could reduce a member’s out-of-pocket costs, Anthem notes.

“If the member has a benefit plan where he or she pays a percentage of the cost, it is possible that his or her percentage of out-of-pocket cost may be reduced,” Anthem says. “This is because the cost to undergo a CT or MRI scan administered in a freestanding imaging facility may be less than what a hospital-based facility would charge. If the member has a facility copay, there may not be a reduction in a member’s out of pocket cost.”

However, the policy still stands even if using a freestanding facility would not reduce the consumer’s out-of-pocket cost, the insurer explains. The approval or denial of the site of service is based only on medical necessity.

In the unlikely event that the physician ignores the policy and the patient receives imaging services in a hospital outpatient setting, the hospital would be responsible for the cost, Anthem says. The patient would not be held responsible unless he or she signed a statement acknowledging the deviation from Anthem policy and agreed to be financially responsible.

Special Report—How to fix the Affordable Care Act

Click to access FierceHealthcare-HowtofixtheAffordaleCareAct.pdf

Image result for aca

As Congress prepares to get back to business, the industry is holding its collective breath to see if healthcare reform will fall off the agenda. It’s pretty clear that rushing through repeal, replace or repair legislation or letting the Affordable Care Act fail isn’t the answer. In this special report, FierceHealthcare’s editors—experts on the business of healthcare—outline ways to fix the nation’s healthcare system.

Hospital Impact: Why preserving value-based care is vital for my health system

There will continue to be a lot of talk about the repeal of the Affordable Care Act over the next weeks and months. From my perspective, I am hopeful that the Trump administration and Congress will keep their focus on the payment aspects of the ACA to ensure affordability for those in need.

My health system has been delivering care under a value-based care delivery model for the last six years, and I don’t want to see that care model go away under the repeal of the law. Quite frankly, this approach to care delivery should be the model for the entire nation.

We have been making a difference in the lives of so many through an approach that provides comprehensive, interdependent care to the sickest of the sick. We started with those patients with multiple comorbidities such as heart disease, diabetes, hypertension and COPD. Through our on-campus Center for Clinical Resources, we can now address their care needs simultaneously through the efforts of physicians, nurse practitioners, nurses, pharmacists, respiratory therapists, dieticians, navigators, community health workers and care coordinators.

The model has been so successful that we are now taking the concept out to the community. We identified “hot spots” throughout our service area where patients with the highest utilization of our health system are located. We applied our high-utilizer determination criteria of three or more bedded visits within 12 months, or six or more emergency department visits with a bedded visit and readmission within 12 months, to determine these patients and their locations. We are now delivering care in homeless shelters, with senior housing, low-income housing, senior centers and churches to follow.

Our goal is to disrupt these high utilizers’ cycle of use by providing services before an ED visit becomes necessary; assisting them to address their social determinants; intervening on any behavioral health issues; introducing those in need to a community health worker who can address any ongoing social needs such as transportation to appointments; and setting them up with a primary care provider for their care going forward.

Two years ago, we introduced our first community garden, and last year our gardens grew to five additional gardens serving those in need. We anticipate the same growth with this model of taking care to the community.

If the ACA is repealed and impacts our care delivery model, programs such as these will go away, leaving the most vulnerable once again in need of the most expensive care rather than enabling us to use the Triple Aim-focused approach to their care.

Where’s the value in accountable care?

Where’s the value in accountable care?

From left: Stephanie Baum of MedCity News, Christina Miles of Aon Hewitt, David Van Houtte of Aetna, Dr. Katherine Schneider of Delaware Valley ACO and Dr. Greg Carroll of GOHealth Urgent Care

Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”

How social factors are driving precision medicine

Precision Medicine2

Mention precision medicine, and genomics quickly comes to the top of mind. While genomics and clinically oriented analysis are extremely valuable in implementing precision medicine as the next step in population health management, they are really only a small part of the big picture.

Increasingly, the value of environmental, social and lifestyle factors that live outside the medical system is also getting recognized in the effective implementation of personalized medicine in this country. The federal government’s Precision Medicine Initiative (PMI) that calls for $215 million in fiscal year 2016 to support research in this area focuses not just on genetics and biology, but also behavior and environment — “with the goal of developing more effective ways to prolong health and treat disease.”

Pursue Healthcare Strategic Partnerships With Caution


Health Care Transformation Task Force Reports Increase in Value-Based Payments

About Health Care Transformation Task Force
Health Care Transformation Task Force is a unique collaboration of patients, payers, providers and purchasers working to lead a sweeping transformation of the health care system. By transitioning to value-based models that support the Triple Aim of better health, better care and lower costs, the Task Force is committed to accelerating the transformation to value in health care. To learn more, visit

The 10 Building Blocks of High-Performing Primary Care

Figure 1

Achieving the triple aim of health reform—better health, improved patient experience, and more affordable costs—is dependent on a foundation of high-performing primary care.

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider