Re: Two questions re: advocacy and the dollar a day plan -report

[Guest guest]

OK but I think October is too late babe. That is why I tried to show you a path now You must go now. I just told you what to say:)Wear black  .

 

Two questions.  1.  Could you spare a little time at IMP camp to talk about putting together a presentation?  Each state seems have some unique set of health care messes.  Massachusetts is in another universe of mess.

Each of us could tick off our own state's particulars to tailor our approach.  Perhaps we could help each other prepare.2.  Tell me about your power earrings. (nb to :  Think of the rakish profile you would cut with one earring.)

Again you made some major ripples into the future.  K

remember- I got the dollar a day plan  from you. Plus ,you  will look  good in  Power earrings.

JeanOn Fri, Jun 18, 2010 at 11:30 AM, Egly  wrote:

 

 I hear you loud and clear.  I am ........ speechless, humbled, and proud to be associated with such a dedicated and tireless leader.  I will reach out to those around me and continue the discussion. 

 

From: 

To:  < >

Sent: Fri, June 18, 2010 8:59:51 AMSubject:  advocacy and the dollar a day plan -report

 I would like to tell the group what I did two days ago I would love for all of us to  find   similar to do I can't type but here goes I have been thinking that I have been  putting my money where my mouth was for 5 yrs now and 

I have the great luck or privilege to have two very good sets of data ( think about what YOU have) One  is the  hows your health data set about patient centered care/ er use/  mammogram rates/  access / efficiency etc A second set is given to me by Maine medicaid- a payor-- they can tell me that my costs for care of patients are far less than the state wide average. I have  zero potentially avoidable hospitalizations / minimal er use etc . I have dollar numbers which is a useful thing to have if you want to  be heard.

I have been thinking that no one knows  that I(YOU) am out here doing this workFinancially things  are not easy here But i am doing( YOU ARE)   goo d quality for lower cost ,and instead of reward for good work i am being battered financially (like many of you)

 So i have begun to write  letters and go visit people( congressman  hospital bd members, whoever I can find:)   ) and so on .Mostly this is weird and useless but i  made a mental list of who i might talk tothen  something came across my desk  also that matched my list , i was reminded of a  woman who runs the Governors office on health finance and policy ( what do you have in your  state?)

 She brings health reform to maine that's her thing  though she has been around for   quite a while and in JAnuary  we get a new governor so who know s what happens to her then...  I called up her  office and asked to go see her

 I have no  blessed idea what i am doing you see   So i drive to the capitol 90min away and she is way down to earth and  has a vague idea who i am( becasue i had already written to the Commisioner  of DHS  about IMP work  and becasue the current head of Medicaid in MAine is a sweet man I used to work for and the medical director of Medicaid used to be an internist across the street--Maine is a small town we say sometimes)

  so the   Governors office on health  finance and policy woman says to  come to a mtg in 2  weeks --that was two days ago This is a mtg of a committee that is to advise the legislature on payment reform It bugs me that  I would never  know there was such a commitee to contact them. Where ARE my professional organziations? ? MAine Medical Association was there 2 days ago why don;t they involve working docs-I   cannot recall- so you wouldn't either -the way these  things work/ whether someone ever told you there might be such  a group that you should talk to...

So anyway  I think oooh . payment reform! warms my little heart!so Trish  gets me on the agenda and I show up So far this is all luck and random event  right? I quake and take imodium/  inderal / valium

 I send to the IMP list serv  before hand ,the dollar day plan so you  can analyze it for meThank you all I try to  figure out  what the heck this mtg is and who people are. I send an email to the medicaid guy  hoping to  figure out how  i as an unpolished amateur  would behave in the land of professionals  .He says,last week , call me on Monday . He says your perspective  has merit and should be  presneted. He says  do not think you will not be well received

 then that NDP  TransForMed  work comes out that so many state projects are modelled on ( including one in MAIne  that gets no money to providers  I think  anyway,and   refused to let me in becasue I  did not have a team).i pored through that stuff  last weekend 

 I rehearse  for the ten minutes they say i can have  I ask  experienced IMPs  to help me--they tell me I will likely be burned at the stake- wear black  so i go and here;s the thing these guys already got alot of this  They already knew that there are a fair number of independent practices in Maine They get that fee for service ain;t workin  and isn't sustainable . And they get   primary care.  They  were, among congessmen locally and others- another former employer ,an NP ,a small business  guy   and the former  chairman of the bd of my residency To whom I explained that not one resident last year not one wen t into practice because they could not afford to.That was powerful stuff to him.

I told them I had come to present compelling data in support of payment reform/ I told them the  four pillars o f  primary care  and that the  way " quality " is measured currently ha s little to do with patients  Etc /You  are IMPS you know the speech

and I handed them a sheet of HYH data  and  my medicaid cost data and  i told them to please consider a pilot project with small practices We have stepped up and done the work We are nimble and can change. LArge practices can do the work but a pilot should i nvovle us

 And I  bravely said gimme a dollar a day. i thought I was nuts. More benzos please.  But I could prove I save the state  far more than that now  so they could do ti  and basically they drank the koolaid There was a lot of  good feedbacka nd  support.

they asked me alot of stuff which I actually like had answers for( thank you IMP masters) They completely  got it   Some policy wonk guy came  up to the podium the head of MAine council on economic development  said " I am struck by  what has been  said by dr a. Just   give her a dollar a day Let her take care of people anyway she needs to; take primary care out  of this insurance mess: "  

 the chairman of the board  said i  lit a fire   with the committee which of course relates to the advice from head IMPs who said i would be burnt  at the stake..:)The head of medicaid emailed me later and said " Nice .  You were the star of  the show "

   I dunno  w hat will happen if anything  and i will leave out the evil blue cross lady whom i wanted to kill ( there were  two panels that testified one providers though i was the only actual working doc there Another person who is always in the state house working on the  pcmh project etc  does see some patients  I think but providers were not there really;.And  a panel  of payors hence  blue cross but also mediciad and  then a few consumers advocate.organizati ons. types. I think the blue cross  woman  knows  that her days are numbered.  What garbage they propagate...

Anyway-  listen IMPs if you do not  find some similarities here  to your state/ your situation what hope is there? This is not about working with insurers- which I think is  useless It is not about trying to t get Washingotn legislators to move which  think is almost useless  Thing s  can and will happen on local levels. It is about possible pilot projects in which money can  be  used in ways we have not  had before. Who will speak for you if you dont; Will we let reform pass us by hoping that someone someplace else will get this  right? CAn you not find who to talk to in your own location?

Please.  go speak. please do it I know nothing but if you as a working doc do not speak then  we are lost.IMPs have data and and substance like noone else has No one knows  you are out there.  You get to say you have been doing innovative work with a   national group /a 501 c3/ that our  work has been published 

  Please go speak. MAny of you were  standing behind me  whne I spoke on wednesday  we can suppor t each other but so many initiatives will go down the  same old roads , run by the same old stakeholders if we do not find a voice and find it fast i think.

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)Email is best used for appointment making and  brief  questions

Email replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .    MD         ph   fax

impcenter.org

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .    MD         

ph   fax impcenter.org

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD    

    ph   fax impcenter.org

[Guest guest]

Ok. Hmm. My neighbor is a state senator. We've been invited for cocktails. Translated, he wants $. But the Massachusetts gov will be there as well. He wants money too. Not a big gathering <50 people. I'll work on a tag line, and buttonhole both. These guys appear to listen when they want campaign funds. Not that I have much, but guess I better RSVP. I'll wear black, for sure, after all a LBD is appropriate anytime.Is black our IMP team color? My foolishness aside. I do understand the enormity.Kathleen (who will be in a blissful no internet -zone for a weekend. sigh)OK but I think October is too late babe. That is why I tried to show you a path now You must go now. I just told you what to say:)Wear black .On Fri, Jun 18, 2010 at 1:05 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote: Two questions. 1. Could you spare a little time at IMP camp to talk about putting together a presentation? Each state seems have some unique set of health care messes. Massachusetts is in another universe of mess.Each of us could tick off our own state's particulars to tailor our approach. Perhaps we could help each other prepare.2. Tell me about your power earrings. (nb to : Think of the rakish profile you would cut with one earring.)Again you made some major ripples into the future. K remember- I got the dollar a day plan from you. Plus ,you will look good in Power earrings.JeanOn Fri, Jun 18, 2010 at 11:30 AM, Egly <kevin_egly> wrote: I hear you loud and clear. I am ........ speechless, humbled, and proud to be associated with such a dedicated and tireless leader. I will reach out to those around me and continue the discussion. From: <jnantonuccigmail>To: < >Sent: Fri, June 18, 2010 8:59:51 AMSubject: advocacy and the dollar a day plan -report I would like to tell the group what I did two days ago I would love for all of us to find similar to do I can't type but here goes I have been thinking that I have been putting my money where my mouth was for 5 yrs now and I have the great luck or privilege to have two very good sets of data ( think about what YOU have) One is the hows your health data set about patient centered care/ er use/ mammogram rates/ access / efficiency etc A second set is given to me by Maine medicaid- a payor-- they can tell me that my costs for care of patients are far less than the state wide average. I have zero potentially avoidable hospitalizations / minimal er use etc . I have dollar numbers which is a useful thing to have if you want to be heard.I have been thinking that no one knows that I(YOU) am out here doing this workFinancially things are not easy here But i am doing( YOU ARE) goo d quality for lower cost ,and instead of reward for good work i am being battered financially (like many of you) So i have begun to write letters and go visit people( congressman hospital bd members, whoever I can find:) ) and so on .Mostly this is weird and useless but i made a mental list of who i might talk tothen something came across my desk also that matched my list , i was reminded of a woman who runs the Governors office on health finance and policy ( what do you have in your state?) She brings health reform to maine that's her thing though she has been around for quite a while and in JAnuary we get a new governor so who know s what happens to her then... I called up her office and asked to go see her I have no blessed idea what i am doing you see So i drive to the capitol 90min away and she is way down to earth and has a vague idea who i am( becasue i had already written to the Commisioner of DHS about IMP work and becasue the current head of Medicaid in MAine is a sweet man I used to work for and the medical director of Medicaid used to be an internist across the street--Maine is a small town we say sometimes) so the Governors office on health finance and policy woman says to come to a mtg in 2 weeks --that was two days ago This is a mtg of a committee that is to advise the legislature on payment reform It bugs me that I would never know there was such a commitee to contact them. Where ARE my professional organziations? ? MAine Medical Association was there 2 days ago why don;t they involve working docs-I cannot recall- so you wouldn't either -the way these things work/ whether someone ever told you there might be such a group that you should talk to...So anyway I think oooh . payment reform! warms my little heart!so Trish gets me on the agenda and I show up So far this is all luck and random event right? I quake and take imodium/ inderal / valium I send to the IMP list serv before hand ,the dollar day plan so you can analyze it for meThank you all I try to figure out what the heck this mtg is and who people are. I send an email to the medicaid guy hoping to figure out how i as an unpolished amateur would behave in the land of professionals .He says,last week , call me on Monday . He says your perspective has merit and should be presneted. He says do not think you will not be well received then that NDP TransForMed work comes out that so many state projects are modelled on ( including one in MAIne that gets no money to providers I think anyway,and refused to let me in becasue I did not have a team).i pored through that stuff last weekend I rehearse for the ten minutes they say i can have I ask experienced IMPs to help me--they tell me I will likely be burned at the stake- wear black so i go and here;s the thing these guys already got alot of this They already knew that there are a fair number of independent practices in Maine They get that fee for service ain;t workin and isn't sustainable . And they get primary care. They were, among congessmen locally and others- another former employer ,an NP ,a small business guy and the former chairman of the bd of my residency To whom I explained that not one resident last year not one wen t into practice because they could not afford to.That was powerful stuff to him.I told them I had come to present compelling data in support of payment reform/ I told them the four pillars o f primary care and that the way "quality" is measured currently ha s little to do with patients Etc /You are IMPS you know the speechand I handed them a sheet of HYH data and my medicaid cost data and i told them to please consider a pilot project with small practices We have stepped up and done the work We are nimble and can change. LArge practices can do the work but a pilot should i nvovle us And I bravely said gimme a dollar a day. i thought I was nuts. More benzos please. But I could prove I save the state far more than that now so they could do ti and basically they drank the koolaid There was a lot of good feedbacka nd support.they asked me alot of stuff which I actually like had answers for( thank you IMP masters) They completely got it Some policy wonk guy came up to the podium the head of MAine council on economic development said"I am struck by what has been said by dr a. Just give her a dollar a day Let her take care of people anyway she needs to; take primary care out of this insurance mess:" the chairman of the board said i lit a fire with the committee which of course relates to the advice from head IMPs who said i would be burnt at the stake..:)The head of medicaid emailed me later and said "Nice . You were the star of the show" I dunno w hat will happen if anything and i will leave out the evil blue cross lady whom i wanted to kill ( there were two panels that testified one providers though i was the only actual working doc there Another person who is always in the state house working on the pcmh project etc does see some patients I think but providers were not there really;.And a panel of payors hence blue cross but also mediciad and then a few consumers advocate.organizati ons. types. I think the blue cross woman knows that her days are numbered. What garbage they propagate...Anyway- listen IMPs if you do not find some similarities here to your state/ your situation what hope is there? This is not about working with insurers- which I think is useless It is not about trying to t get Washingotn legislators to move which think is almost useless Thing s can and will happen on local levels. It is about possible pilot projects in which money can be used in ways we have not had before. Who will speak for you if you dont; Will we let reform pass us by hoping that someone someplace else will get this right? CAn you not find who to talk to in your own location?Please. go speak. please do it I know nothing but if you as a working doc do not speak then we are lost.IMPs have data and and substance like noone else has No one knows you are out there. You get to say you have been doing innovative work with a national group /a 501 c3/ that our work has been published Please go speak. MAny of you were standing behind me whne I spoke on wednesday we can suppor t each other but so many initiatives will go down the same old roads , run by the same old stakeholders if we do not find a voice and find it fast i think.-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

[Guest guest]

A bit goth wouldn't you say except for Black Tie affairs??? We want to project the concept of saving lives not being the patients undertakers for goodness sake.... I say let's be patriotic with Red, White and Blue, with either Blue or White at the main color with Trim of the other two.... Or we could have home and away jersey's. Blue for Home and wear our light colors, White with R & B trim on the Road Games... NHL and NFL have home team in their Colors or Dark Jerseys with the vistors in their light colors.... "Let's Go IIII-Deals, Oh lay, oh lay.... Let's Go IIII-Deals Oh lay, oh lay!!!!"

To: Sent: Fri, June 18, 2010 3:57:44 PMSubject: Re: Two questions re: advocacy and the dollar a day plan -report

Ok. Hmm. My neighbor is a state senator. We've been invited for cocktails. Translated, he wants $. But the Massachusetts gov will be there as well. He wants money too. Not a big gathering <50 people. I'll work on a tag line, and buttonhole both. These guys appear to listen when they want campaign funds. Not that I have much, but guess I better RSVP. I'll wear black, for sure, after all a LBD is appropriate anytime.

Is black our IMP team color?

My foolishness aside. I do understand the enormity.

Kathleen (who will be in a blissful no internet -zone for a weekend. sigh)

OK but I think October is too late babe. That is why I tried to show you a path now You must go now. I just told you what to say:)Wear black .

On Fri, Jun 18, 2010 at 1:05 PM, Kathleen Patton <krpattoncomcast (DOT) net> wrote:

Two questions. 1. Could you spare a little time at IMP camp to talk about putting together a presentation?

Each state seems have some unique set of health care messes. Massachusetts is in another universe of mess.

Each of us could tick off our own state's particulars to tailor our approach. Perhaps we could help each other prepare.

2. Tell me about your power earrings.

(nb to : Think of the rakish profile you would cut with one earring.)

Again you made some major ripples into the future.

K

remember- I got the dollar a day plan from you. Plus ,you will look good in Power earrings.Jean

On Fri, Jun 18, 2010 at 11:30 AM, Egly <kevin_eglyyahoo (DOT) com> wrote:

I hear you loud and clear. I am ........ speechless, humbled, and proud to be associated with such a dedicated and tireless leader. I will reach out to those around me and continue the discussion.

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1 <Practiceimprovement 1yahoogroups (DOT) com>Sent: Fri, June 18, 2010 8:59:51 AMSubject: [Practiceimprovemen t1] advocacy and the dollar a day plan -report

I would like to tell the group what I did two days ago

I would love for all of us to find similar to do I can't type but here goes I have been thinking that I have been putting my money where my mouth was for 5 yrs now and I have the great luck or privilege to have two very good sets of data ( think about what YOU have) One is the hows your health data set about patient centered care/ er use/ mammogram rates/ access / efficiency etc A second set is given to me by Maine medicaid- a payor-- they can tell me that my costs for care of patients are far less than the state wide average. I have zero potentially avoidable hospitalizations / minimal er use etc . I have dollar numbers which is a useful thing to have if you want to be heard.I have been thinking that no one knows that I(YOU) am out here doing this workFinancially things are not easy here But i am doing( YOU

ARE) goo d quality for lower cost ,and instead of reward for good work i am being battered financially (like many of you) So i have begun to write letters and go visit people( congressman hospital bd members, whoever I can find:) ) and so on .Mostly this is weird and useless but i made a mental list of who i might talk tothen something came across my desk also that matched my list , i was reminded of a woman who runs the Governors office on health finance and policy ( what do you have in your state?) She brings health reform to maine that's her thing though she has been around for quite a while and in JAnuary we get a new governor so who know s what happens to her then... I called up her office and asked to go see her I have no blessed idea what i am doing you see So i drive to the capitol 90min

away and she is way down to earth and has a vague idea who i am( becasue i had already written to the Commisioner of DHS about IMP work and becasue the current head of Medicaid in MAine is a sweet man I used to work for and the medical director of Medicaid used to be an internist across the street--Maine is a small town we say sometimes) so the Governors office on health finance and policy woman says to come to a mtg in 2 weeks --that was two days ago This is a mtg of a committee that is to advise the legislature on payment reform It bugs me that I would never know there was such a commitee to contact them. Where ARE my professional organziations? ? MAine Medical Association was there 2 days ago why don;t they involve working docs-I cannot recall- so you wouldn't either -the way these things work/ whether someone ever told you there might be such a group

that you should talk to...So anyway I think oooh . payment reform! warms my little heart!so Trish gets me on the agenda and I show up So far this is all luck and random event right? I quake and take imodium/ inderal / valium I send to the IMP list serv before hand ,the dollar day plan so you can analyze it for meThank you all I try to figure out what the heck this mtg is and who people are. I send an email to the medicaid guy hoping to figure out how i as an unpolished amateur would behave in the land of professionals .He says,last week , call me on Monday . He says your perspective has merit and should be presneted. He says do not think you will not be well received then that NDP TransForMed work comes out that so many state projects are modelled on ( including one in

MAIne that gets no money to providers I think anyway,and refused to let me in becasue I did not have a team).i pored through that stuff last weekend I rehearse for the ten minutes they say i can have I ask experienced IMPs to help me--they tell me I will likely be burned at the stake- wear black so i go and here;s the thing these guys already got alot of this They already knew that there are a fair number of independent practices in Maine They get that fee for service ain;t workin and isn't sustainable . And they get primary care. They were, among congessmen locally and others- another former employer ,an NP ,a small business guy and the former chairman of the bd of my residency To whom I explained that not one resident last year not one wen t into practice

because they could not afford to.That was powerful stuff to him.I told them I had come to present compelling data in support of payment reform/ I told them the four pillars o f primary care and that the way "quality" is measured currently ha s little to do with patients Etc /You are IMPS you know the speechand I handed them a sheet of HYH data and my medicaid cost data and i told them to please consider a pilot project with small practices We have stepped up and done the work We are nimble and can change. LArge practices can do the work but a pilot should i nvovle us And I bravely said gimme a dollar a day. i thought I was nuts. More benzos please. But I could prove I save the state far more than that now so they could do ti and basically they drank the koolaid There was a lot of good feedbacka nd

support.they asked me alot of stuff which I actually like had answers for( thank you IMP masters) They completely got it Some policy wonk guy came up to the podium the head of MAine council on economic development said"I am struck by what has been said by dr a. Just give her a dollar a day Let her take care of people anyway she needs to; take primary care out of this insurance mess:" the chairman of the board said i lit a fire with the committee which of course relates to the advice from head IMPs who said i would be burnt at the stake..:)The head of medicaid emailed me later and said "Nice . You were the star of the show" I dunno w hat will happen if anything and i will leave out the evil blue cross lady whom i wanted to kill ( there were two panels that testified

one providers though i was the only actual working doc there Another person who is always in the state house working on the pcmh project etc does see some patients I think but providers were not there really;.And a panel of payors hence blue cross but also mediciad and then a few consumers advocate.organizati ons. types. I think the blue cross woman knows that her days are numbered. What garbage they propagate...Anyway- listen IMPs if you do not find some similarities here to your state/ your situation what hope is there? This is not about working with insurers- which I think is useless It is not about trying to t get Washingotn legislators to move which think is almost useless Thing s can and will happen on local levels. It is about possible pilot projects in which money can be used in ways we have not had

before. Who will speak for you if you dont; Will we let reform pass us by hoping that someone someplace else will get this right? CAn you not find who to talk to in your own location?Please. go speak. please do it I know nothing but if you as a working doc do not speak then we are lost.IMPs have data and and substance like noone else has No one knows you are out there. You get to say you have been doing innovative work with a national group /a 501 c3/ that our work has been published Please go speak. MAny of you were standing behind me whne I spoke on wednesday we can suppor t each other but so many initiatives will go down the same old roads , run by the same old stakeholders if we do not find a voice and find it fast i think.-- PATIENTS-please remember that email may not be entirely secure, and that

Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

[Guest guest]

Kathleen,

Sounds like a great opportunity.  Talk to or Gordon or someone on the phone before to talk through your speaking points.

You go girl!Sharon