Monthly Archives: March 2014

healthy habits, nutrition, policy, rapid learning health systems

Too cool… Tetris is good for you???

  • Of the 119 people that participated, 80 reported craving something: 58 people wanted food or drink of some kind, 10 wanted caffeine, and 12 wanted nicotine.
  • Their mean craving levels were “reasonably high,” the researchers write. Playing Tetris reduced their cravings by about 24 percent.
  • The relationship between playing the game and craving reduction remained statistically significant, even when the researchers accounted for a general lessening of the craving over time, or removed the people who were only slightly craving something.

 

  • Potential confounder: doing nothing for three minutes could have resulted in an increase in cravings!????

http://www.theatlantic.com/health/archive/2014/02/playing-tetris-can-reduce-urges-to-eat-smoke-drink/284056/

Playing Tetris Can Reduce Urges to Eat, Smoke, Drink

Three minutes of the game reduced cravings by 24 percent in a recent study.
Richard Drew/AP

The never-ending falling blocks of Tetris have caused innumerable people untold amounts of frustration. YouTube star Hank Green even has a song memorializing the evil of “The Man Who Throws The Tetris Piece.” But a new study published in Appetite shows that the unwinnable game may be good for something other than wasting hours, days, lives—reducing cravings.

The Plymouth University researchers—graduate student Jessica Skorka-Brown and professors Jackie Andrade and Jon May—tested Elaborated Intrusion Theory, which says that cravings rely heavily on visual imagery. They write that this is the first test of that theory using naturally-occurring cravings. To capture the 119 participants’ natural cravings (rather than artificially inducing them in the lab by having them evaluate chocolates or something),  asked them when they came in for the experiment if they were currently craving something, and to rate their craving from 1 to 100. Participants completed the Craving Experience Questionnaire, which measured the “strength, imagery, vividness, and intrusiveness of their current craving.”

Then participants sat down in front of a computer, which either loaded Tetris for them to play, or looked like it was going to load Tetris but never actually did. They either played Tetris, or didn’t, for three minutes and then answered the same questions about their craving, describing what happened to the craving while they were playing the game (or, you know, sitting there).

(YouTube)

Of the 119 people that participated, 80 reported craving something: 58 people wanted food or drink of some kind, 10 wanted caffeine, and 12 wanted nicotine. Their mean craving levels were “reasonably high,” the researchers write. Playing Tetris reduced their cravings by about 24 percent. The relationship between playing the game and craving reduction remained statistically significant, even when the researchers accounted for a general lessening of the craving over time, or removed the people who were only slightly craving something.

Obviously a 24 percent reduction doesn’t mean the craving is gone, but neither is that nothing. “Tetris reduced the vividness and frequency of craving imagery, as well as craving intensity,” the study reads. Tetris is a very visual task, which the researchers posit may be why it seems to impede the strength of craving imagery.

Strange as it may seem, Tetris could actually be a helpful tool for those trying to quit smoking, or just avoid indulging in an unhealthy snack. Because despite its frustrations, Tetris is one of the most popular video games ever—people like playing it. And if three minutes of arranging colored blocks could help curb a craving, it might be worth logging onto FreeTetris.org the next time you feel one hit.

healthy habits, nutrition, policy

Better blooded vegans

  • Vegans have lowest blood pressure
  • Meat increases your blood pressure
  • Brocolli has 1g protein per spear
  • Vegan animals can be strong too
  • Interview with Neal Barnard – avid vegan
  • Nice pot shots from Katz

http://www.theatlantic.com/health/archive/2014/02/vegetarians-and-their-superior-blood/284036/

Vegetarians and Their Superior Blood

A plant-based diet can lower your blood pressure, according to research released today in a major medical journal. Should we really stop eating meat before starting medication?
Frozen oranges in California, December 2013 (Gary Kazanjian/AP)

“Let me be clear about this. A low carbohydrate diet is quackery,” Dr. Neal Barnard told me over the phone. “It is popular, bad science, it’s a mistake, it’s a fad. At some point we have to stand back and look at evidence.”

Note to self: Don’t ask Dr. Neal Barnard about limiting your carb intake.

“You look at the people across the world who are the thinnest, the healthiest, and live the longest; they are not following anything remotely like a low-carb diet,” he said. “Look at Japan. Japan has the longest-lived people. What is the dietary staple in Japan? They’re eating huge amounts of rice.”

Based on the fact that Barnard is the author of 15 books extolling the life-prolonging virtues of plant-based diets, I should have seen that coming. Apparently I’m one of few people in health media not familiar with his work, and his very clear perspective. I heard about Barnard because today he and his colleagues published a meta-analysis in the prestigious Journal of the American Medical Association: Internal Medicine that confirmed a very promising health benefit of being a vegetarian: an enviably lower blood pressure than your omnivorous friends.

The publicist for an organization called the Physician’s Committee on Responsible Medicine emailed me to ask if I’d like to talk with Barnard about the research, and I always do want to talk about food research, so I did. High blood pressure shortens lives and contributes to heart disease, kidney failure, dementia, and all sorts of bad things, so any reasonable dietary way to treat or prevent it is worth considering. We’ve known for years that vegetarianism and low blood pressure are bedfellows, but the reason for it hasn’t been clear.

“We looked at every published study, so it’s really undeniably true,” Barnard said at the outset of our conversation, in a manner that anticipated a denial I wasn’t prepared to offer. “People who follow vegetarian diets, they’ve got substantially lower blood pressures. [The effect] is about half as strong as taking a medication.”

In this case substantially means that when you look at all of the controlled research trials comparing any kind of vegetarian diet to an omnivorous diet, the average difference in systolic blood pressure (the top number in the standard “120 over 80” jive) is about five millimeters of mercury. In diastolic blood pressure decrease (the bottom number) the difference is two. Not nothing, but not earth-shattering.

There have been a number of blood pressure studies on vegetarian diets in recent years, most famously the U.S. National Institutes of Health’s 2006 DASH (Dietary Approaches to Stop Hypertension) studies. DASH was inspired by observations that “individuals who consume a vegetarian diet have markedly lower blood pressures than do non-vegetarians.” It ended up recommending a diet high in fruits and vegetables, nuts, and beans; though it did not tell us to go all-out vegetarian.

“What’s new here is that we were able to get a really good figure for an average blood pressure lowering effect,” Barnard said. “Meta-analysis is the best kind of science we do. Rather than just picking one study or another to look at, you go after every study that has been published that weighs in on this question.”

In addition to the seven controlled trials (where you bring in people and change their diets, then compare them with a control group eating everything), the researchers also reviewed 32 different observational studies. Those are less scientifically valid than controlled studies, but they showed even larger decreases in blood pressure between vegetarian and omnivorous diets (6.9 systolic, 4.7 diastolic).

“It’s not uncommon for us to see patients at our research center who come in and they’re taking four drugs for their blood pressure, and it’s still too high. So if a diet change can effectively lower blood pressure, or better still can prevent blood pressure problems, that’s great because it costs nothing, and all the side effects are ones that you want, like losing weight and lowering cholesterol.”

The research center to which Barnard refers is that of Physicians Committee for Responsible Medicine (PCRM). Barnard is president. Founded in 1985, PCRM describes itself as an “independent nonprofit research and advocacy organization.” The advocacy is for ethical human and animal experimentation. According to its website, PCRM “promote(s) alternatives to animal research and animal testing. We have worked to put a stop to gruesome experiments, such as the military’s cat-shooting studies, DEA narcotics experiments, and monkey self-mutilation projects.”

Unloading vegetables from a boat on a foggy January morning in Bangladesh (A.M. Ahad/AP)

“Neal is a good guy and does good work,” Dr. David Katz, Director of Yale University’s Prevention Research Center, told me, “but the name of the organization is entirely misleading. It is not about responsible medical practice. It is entirely and exclusively about promoting vegan eating. A laudable cause to be sure, but I prefer truth in advertising.”

The PCRM research group has another academic article published this week that found that a meat-based diet increases one’s risk of type-two diabetes and should be considered a risk factor. Barnard’s anti-meat orientation became pretty clear as I talked more with him about today’s study.

“One way of thinking about it is that a vegetarian diet lowers blood pressure,” he said, “But I like to switch it around: A meat-based diet raises blood pressure. We now know that, like cigarettes, if a person is eating meat, that raises their risk of health problems.”

Barnard’s blood-pressure study did not distinguish one type of vegetarianism from another. I asked what he thought of eggs and milk, at this point expecting that they wouldn’t be a good idea.

“A semi-vegetarian diet does help some. We might suspect that a vegan pattern is going to be the best simply because studies have shown that vegans are the thinnest,” he said. “People who add cheese and eggs tend to be a little heavier, although they’re always thinner than the meat eaters. We have suspected that when people go vegan their blood pressures will be a little bit lower, but so far the data don’t really show that.”

Weight gain aside, because that is a different variable, why do vegetarians have lower blood pressure? “Many people will say it’s because a plant-based diet is rich in potassium,” Barnard said. “That seems to lower blood pressure. However, I think there’s a more important factor: viscosity, how thick your blood is.”

Eating saturated fat has been linked to viscous blood and risk for high blood pressure, according to the World Health Organization, as compared to polyunsaturated fats. Barnard paints an image of bacon grease in a pan that cools and solidifies into a waxy solid. “Animal fat in your bloodstream has the same effect,” he says. “If you’re eating animal fat, your blood is actually thicker and has a hard time circulating. So the heart has to push harder to get the blood to flow. If you’re not eating meat, your blood viscosity drops and your blood pressure drops. We think that’s the more important reason.”

Unprompted and seemingly apropos of nothing, we move into one of my favorite topics, Thanksgiving.

“You know how on Thanksgiving everyone kind of dozes off? People say it’s the tryptophan in the turkey, but it’s not. It’s all the gravy and the grease that’s entered their bloodstream. It reduces the amount of oxygen that’s getting to their brain and they just fall asleep.”

“That’s terrifying.”

“And what else could be affected by blood flow? One thing might be athletic performance. Take the fastest animals, take a stallion, they don’t eat meat or cheese, so their blood is not viscous at all. Their blood flows well. As you know a lot of the top endurance athletes are vegan. Scott Jurek is the most amazing ultra-distance runner in the world. That’s why Jurek says a plant-based diet is the only diet he’ll ever follow. Serena Williams is going vegan, too. A lot of  endurance athletes are doing it. If you consider tennis an endurance sport.”

“I do,” I said. “It is.” Venus and Serena Williams have been outspoken in their raw veganism for years. “Where should we be getting the protein to rebuild our muscles after a 100-mile run,” I asked, “if there’s no meat on the table?”

“Well, the same place that a stallion or a bull or an elephant or a giraffe or a gorilla or any other vegan animal gets it. The most powerful animals eat plant-based diets. If you’re a human, you can eat grains, beans, and even green leafy vegetables. Broccoli doesn’t want to brag, but it’s about one-third protein.”

I can’t speak for broccoli, but I do think the broccoli-growers association could consider that as a slogan. (Though, if you Google “Broccoli doesn’t want to brag,” it turns out Barnard said the same thing during an appearance on The Dr. Oz Show, so maybe he already owns it.) Broccoli does have one gram of protein per five-inch spear. That means 56 broccoli spears would get an adult man to the CDC‘s recommended daily protein allowance. For an ultra-marathoner it would be two or three times that.

“As for the findings [in this meta-analysis],” Katz told me, “they are valid, and show yet again that we could be eating far better than we do. The potentially misleading message is that veganism (or, more generally, vegetarianism) is the only way to eat to lower blood pressure.”

The DASH diet studies showed that including dairy was more effective for lowering blood pressure than a strictly plant-based diet.

“That isn’t an argument for dairy,” Katz continued, “there are considerations other than blood pressure, of course. But it highlights the tendency for nutrition researchers with any given agenda to emphasize that portion of a larger truth in which they are personally invested. For what it’s worth, Mediterranean diet studies also show blood pressure reduction.”

healthcare, healthy habits, nutrition, policy

Vegetarian diet lowers blood pressure… derrrrr!

  • Japanese meta-analysis in JAMA Int Med shows lowered blood pressure on vegetables by 5mmHg
  • similar to low sodium diet, loss of 5kg, half the effect of meds

http://www.foodnavigator-usa.com/R-D/Vegetarian-diet-could-slash-blood-pressure-Meta-analysis/

Vegetarian diet could slash blood pressure: Meta-analysis

Post a comment25-Feb-2014

Related tags: Vegetarian, Diet, Meat, Blood pressure, Heart health

Related topics: R&D

Consuming a vegetarian diet may be associated with lower blood pressure, and as such could be used to reduce blood pressure and heart disease risk, say researchers.

RELATED NEWS:

Vegetarians have significantly lower mortality rates, reveals new study
Veg congress day one: The fact vegetarians are healthier than meat-eaters is ‘one of the most consistent findings of nutritional epidemiology’
Vegetarian diet could slash heart disease risk by a third, say EPIC researchers
Vegetarian meal sales to top £882M by 2016

The meta-analysis of seven clinical trials and 32 studies in which participants consumed a vegetarian diet, finds consumption of a vegetarian diet is associated with lower blood pressure (BP).

Led by Dr Yoko Yokoyama from the National Cerebral and Cardiovascular Center, Japan, the team behind the analysis pooled measurements on net differences in BP associated with eating a vegetarian diet from 311 clinical trial patients and more than 21,000 participants in observational studies.

Writing in the journal JAMA Internal Medicine, Yokoyama and his team said that their results suggest such diets could be a useful nonpharmacologic means for reducing blood pressure.

“The meta-analysis indicates an overall difference in systolic BP of −4.8 mm Hg in controlled trials and −6.9 mm Hg in observational studies,” revealed the research team.

“These effect sizes are similar to those observed with commonly recommended lifestyle modifications, such as adoption of a low-sodium diet or a weight reduction of 5 kg, and are approximately half the magnitude of those observed with pharmaceutical therapy, such as administration of angiotensin-converting enzyme inhibitors to individuals with hypertension,”they added.

Yokoyama and colleagues commented that further studies are now required to clarify which types of vegetarian diets are most strongly associated with lower blood pressure, adding that research into the implementation of such diets, either as public health initiatives aiming at prevention of hypertension or in clinical settings, “would also be of great potential value.”

Source: JAMA Internal Medicine
Published online ahead of print, doi: 10.1001/jamainternmed.2013.14547 
“Vegetarian Diets and Blood Pressure: A Meta-analysis”
Authors: Yoko Yokoyama, Kunihiro Nishimura, et al

complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, meaning, nutrition, policy, politics, quantified self, rapid learning health systems, startup

Wellthcare

Lissanthea put me on to this project.

Sounds highly aligned to my own ambitions, similarly requiring more focus…

http://www.wellthcare.com/

Wellthcare is an exploration

It’s an attempt to find new ways to value and create health

Health care contributes only 20% to our health and yet it dominates the health discourse;
80% of our health comes from our genes, behaviours, social factors and the environment

Wellthcare is about the 80% 
It’s about finding new sources of health-related value
It’s about creating health

At Wellthcare we believe that much of this value resides in our networks and communities

We call this value Wellth

Recent Log posts 

Pernicious moralising: when public health fails
22 Feb 2014
Wellthcare receives its first grant 
6 Feb 2014
It’s time to prioritise health creation – not just care and prevention 
30 Jan 2014
How a talking pet can keep us healthy
15 Jan 2014
Angelina Jolie, the end of standard, confused value, and not enough failure: why 2013 mattered
30 Dec 2013

Despatches from the Wellthcare Explorers 

Despatches are detailed descriptions of the debates being had between the Wellthcare Explorers as they further discuss health creation. 

Is there a role for an ‘event’? (PDF)
Published February 28th 2014

Building Resilience: Understanding People’s Context and Assets (PDF)
Published December 11th 2013

Fragmenting Communities and the Wantified Self (PDF)
Published October 22nd 2013

Discovering Wellth (PDF)
Published September 26th 2013
Exploration timeline 

Wellthcare is being explored by its Pioneer, Pritpal S Tamber, and an eclectic group of thinkers and doers called the Wellthcare Explorers.

February 2014

  • The fourth debate between the Wellthcare Explorers on the aims of an international meeting on health creation (Despatch pending)

January 2014 

  • Grant from Guy’s and St Thomas’ Charity received to ascertain whether it is possible to hold an international meeting on health creation (see announcement)
  • Wellthcare Manifesto drafted (publication pending)

December 2013

  • Wellth definition changed to: ‘new, health-related value, defined by what people want to do, supported by their nano-networks and communities’

November 2013 

  • Third debate between Explorers followed by Despatch

October 2013

  • The idea of the ‘Wantified Self’ described
  • Second debate between Explorers followed by Despatch
  • Wellth definition changed to: ‘new, health-related value, defined by what people want to do, supported by their nano-networks’

September 2013 

  • First debate between Explorers followed by Despatch

June 2013

  • Website launched
  • Wellth defined as ‘reclaimed currencies of health, delivered through new technologies, nurtured and protected by intimate communities’

May 2013

Feb 2013

  • Work starts on Wellthcare
business, data saving lives, healthcare, policy, politics, rapid learning health systems

The business case for value-based care

  •  value-based payments will come into the US in the next 5-10 years
  • payments will be based on conditions, not treatments
  • e.g. current c-section rates are highly variable, due to the way fees are paid, not their actual value

 

http://www.healthleadersmedia.com/print/COM-301451/Building-the-Business-Case-for-ValueBased-Care

Building the Business Case for Value-Based Care

John Commins, for HealthLeaders Media , February 26, 2014

 

Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, discusses a fundamental barrier to shifting payment models in healthcare: Some providers mistakenly think all they have to do is tweak existing fee-for-service billing structures without understanding what drives costs in the underlying payment system.

Harold D. MillerHarold D. Miller, President and CEO
Center for Healthcare Quality
and Payment Reform

The shift away from volume-based, fee-for-service billing towards value-based reimbursements is gaining momentum and will be largely in place over the next few years. And yet a surprising number of healthcare providers really don’t grasp the details of how value-based reimbursements work.

Harold D. Miller, president and CEO of the non-profit Center for Healthcare Quality and Payment Reform, says many providers mistakenly believe that all they have to do is tweak existing fee-for-service billing structures without identifying potential savings or understanding what drives costs in the underlying payment system.

Miller, the author of a Robert Wood Johnson Foundation-funded report called Making the Business Care for Payment and Delivery Reform, spoke with me this week about what providers must do to build an effective business case for value-based care. The following is an edited transcript.

HLM: Where are we on the fee-for-service/value-based care timeline?

Miller: It could be the dominant model within the next five to 10 years, but it is a matter of how quickly physicians and in particular physicians in hospitals meet with the purchasers of care— the employers— to work that out. It’s about how soon both side come together and create the win, win, win that is good for patients, providers, and purchasers.

HLM: What are the stumbling blocks on the road to value-based care?

Miller: Most health plans and Medicare are trying to change the way care is delivered and reduce costs by piling on pay for performance and shared savings on top of fee-for-service. The problem is that if you don’t change the underlying payment system, you don’t change the incentives and the barriers that it creates.

For example, one of the best ways to keep people with chronic disease healthier and out of the hospital is for a physician practice to hire a nurse to educate and encourage patients to call when they have a problem. The problem is that doctors don’t get paid for nurses and they don’t get paid for answering phone calls. So practices are forced to lose money under fee-for-service to deliver better care, even though it would actually save money by keeping the patients out of the hospital.

 

HLM: Is value-based healthcare a particularly challenging sector?

Miller: Every patient is different, but on the other hand, how do health insurance companies operate? The law of large numbers says that on average, patients are fairly similar. You don’t have to deliver the exact same treatment to everybody to estimate on average what it is going to be like.

If you get the unusually expensive case—the patient who is an outlier with unique health problems— that is what insurance is for.

On the other hand, saying ‘We shouldn’t be giving an MRI to everyone who comes in with lower back pain. Most of them should probably go to physical therapy first.’ That is something you can do across a broad number of patients. That is going to save money on average and probably be better for the patients.

HLM: Is there common ground for fee-for-service and value-based models that providers can build on?

Miller: A lot of the payment reforms that are being done actually build on fee-for-service. The idea is you don’t just leave it in place and try to pile something on top. The problem with fee-for-service now is that it says you get paid the exact same amount to do something whether you do it well or poorly and whether or not [or whether] there are complications or infections that occur. And in fact you may get paid more.

But you don’t fix fee-for-service by sticking little penalties or bonuses on top. You have to change the fundamental way it is delivered.

For example, for patients who have health problems, we are looking at payments based on the patient’s condition and not based on exactly the procedure you used. A good example is delivering a baby. You get paid more to do a caesarian section than you get paid than a vaginal delivery. Yet the vaginal delivery takes longer, and is better for the mother and the baby.

So why do we now have a 33% C-section rate in the country? Because the fees we pay are not based on the actual value.

 

HLM: Why does value-based care create so much unease among many providers?

Miller: A lot of the anxiety comes because people don’t have the data. You have to have access to good data and in most cases healthcare providers can’t do that. Medicare has only just recently started to release data, so that someone could actually do the kind of analysis that I recommend in my report.

Most health plans treat their data as a proprietary secret, but there are a number of communities around the country that have multi-payer claims databases where people can do these kinds of analyses.

HLM: Why should providers welcome the switch to value-based care?

Miller: You could actually do better in a value-based payment model. People have the perception that somehow it is going to be worse, but the sooner you get into it the better you may be able to do because you are able to capture a lot of the value out there now that isn’t being captured.

Rather than staying in fee-for-service and hoping you may get a small increase in fees or that you don’t get a cut in fees, it’s better to ask ‘Can I redesign care in a way that would allow me to be paid significantly more?’

Medicare has done a demonstration that has been operational now for several years called theAcute Care Episode Demonstration that bundled together hospital and physician payments for orthopedic and cardiac procedures and the physicians were able to earn up to 25% more than their standard fee-for-service payments by being able to redesign care and reduce the costs. That is far more of an increase in pay quickly than you could ever get by simply staying in the existing fee-for-service model.

HLM: Who should be at the table when providers build the business case for value-based care?

Miller: Step No. 1 is changing the way care is delivered. It is the physicians on the front lines who have to say ‘Where do we think we are actually doing too much of something we shouldn’t do or that we are not providing good care to the patients?’

 

Then you have to get the COO or the CFO to say ‘Let’s work the numbers.’ Typically, you don’t find those two parts of organizations working together. Doing spreadsheets is not the physicians’ skill and providing care is not the CFO’s skill. But if you can get them to come together, that is where the magic happens.

Payment Reform

You say to physicians ‘Where do you think you could redesign care if somebody gave you the flexibility to be paid differently, to be paid for things that you aren’t being paid for today?’ When I talk to physicians, they all have ideas but nobody asks them.

The typical approach is that physicians say ‘Pay me for these things that you don’t pay me for today.’ The health plan, Medicare, employers or whomever says, ‘Wait a minute. That will increase costs if you are going to be paid for something new.’ If you think it is going to be better, run the numbers to see if it actually will save money. What will you do less of and what will that save?

Get everybody in the room. Get their ideas. Figure out which subset appears to be the most promising. Do the detail work and go to payers to put it in place. If you can show success then that encourages people to do more. Not every case will it be a savings proposition.

Which of those things is there really a business case for, and if there seems to be a business case then let’s do a finer analysis to show that and take it to the payers to say ‘how about a deal here?’ Even if you can’t get the perfect data, using approximate data to at least see if it looks like a business case then tells you which things to focus on.

HLM: How soon could a value-based model see a return on investment?

Miller: For many of these things, the savings can happen very quickly. A lot of what has been done in healthcare has been desirable, but has a long-term payoff. There is a lot of focus on better management of diabetes and hypertension; all very desirable but it doesn’t save a lot of money this year.

 

On the other hand, if you focus on people going unnecessarily to the emergency room and getting unnecessary tests and [you] figure out how to redesign that care, you save money immediately because you are avoiding the unnecessary care. Thirty day re-admissions are a perfect example.

HLM: Who do providers speak with on the payer side?

Miller: The focus will differ. Medicare doesn’t have a whole lot of interest in maternity care, whereas for businesses and Medicaid maternity care is in many cases their biggest expenditures. Everyone is interested in chronic disease. The distinction I make is between the purchaser and the payer. The purchaser in commercial insurance is the employer.

In fact, 60% of commercially insured employees in the country are in self-insured employer plans. The deal you are working out is actually with the employer and not the health plan. All the health plan is doing is processing claims. One of the challenges for commercial health plans is that value-based isn’t necessarily a good business proposition for them. They may have to incur costs to change the payment system, but the savings don’t go to them, they go back to their self-insured accounts.

HLM: What influences will insurance exchanges and consumer-driven healthcare play in the business case for value-based care?

Miller: It could be a potential advantage if different provider organizations get beyond this fairly narrow shared-savings model to the point where they are actually able to take accountability for populations of patients and can price that.

They could go on the exchange and allow people to sign up for this ACO and pick a primary care physician there and work with the coordinated set of docs at a lower cost and higher quality than simply picking a generic health plan. It’s kind of halfway between the traditional HMO/PPO models. You are picking who you want to lead your care. You don’t necessarily have to be limited to once set of docs or have a gatekeeper for everything.

John Commins is a senior editor with HealthLeaders Media.