My wife and I moved “back” to Milwaukee in early 2022. I say back because I actually grew up in South Florida, but my family is originally from the Greater Milwaukee area. My grandfather owned the old Port of Sound audio/electronics store in the Bayshore shopping center. My mom went to Washington High School and my dad went to John Marshall. After meeting at Echo Bowl (the site of what is now a Walgreens) on Port Washington Road, and going on dates to Kopp’s Frozen Custard, they both attended the University of Wisconsin-Madison and got married. Dad graduated medical school a double Badger, and then my parents left Wisconsin for dad’s residency and fellowship; eventually settling in the Greater Ft. Lauderdale area.

From my youngest years, through high school, my brother and I would spend parts of our summer break visiting family in Glendale and Mequon. We’d head up to the Wisconsin Dells, drive down to Six Flags Great America, or we’d drive like maniacs on go-karts at Johnson’s Park before going in to play the arcade games (believe it or not, you used to have to put quarters into a machine to play video games). I can’t tell you how many times we went back to Kopp’s as it’s my mother’s (and ours) sentimental favorite frozen custard spot (and routinely named one of America’s top burger joints). Believe it or not, my mom attempted to coax them into opening a satellite location in South Florida back in the 1980s (that idea was quickly denied). We went to Summerfest, the State Fair, Door County, and long before the Florida (now Miami) Marlins existed near our home, I was attending Milwaukee Brewers games at old County Stadium.

I was constantly telling friends back home how much I loved Milwaukee, so much so that my wife joked I was “Mr. Milwaukee” to her. The reality is there’s a lot of people who could claim that title; most more qualified than me, because once you’ve been to, or lived in, Milwaukee it stays with you.

When we had the opportunity to move to Milwaukee for my wife’s job, I’d be remiss to say it seemed a little serendipitous. What I’ve learned in the year-and-a-half since we arrived is that Milwaukee is evolving into something even better than the city my parents moved from. It’s changing, growing, improving. This isn’t my parents’ Milwaukee anymore, and I believe that those who haven’t experienced it must add it to their travel bucket lists. As LeVar Burton is known to say, “You don’t have to take my word for it,” though. Milwaukee was named one of National Geographic’s Top 5 spots to travel to in 2023, named a top-three U.S. large city in Condé Nast Traveler 2023 Readers’ Choice Awards (including their own little best of Milwaukee article), and written about in Time Magazine as a city people are starting to move to.

As we raise our family here, which it’s a great place to do so, I see that there really is something for everyone in Milwaukee. Here’s a lot of what I love about this city…

FOOD

I mentioned Kopp’s Frozen Custard twice already, but Milwaukee isn’t just burgers and shakes anymore (although there’s definitely still plenty of that around). Over the last few years there’s been a significant increase in innovative culinary experiences and top chefs in the area. It used to be that you had to drive down to Chicago, fly to New York, or book a trip to northern California. Not anymore. In 2022 Milwaukee had nine James Beard semifinalists. They included (listed alphabetically):

• Amilinda
• Bavette La Boucherie
• Blue’s Egg
• Buttermint Finer Dining & Cocktails
• The Diplomat (2022 Winner)
• EsterEv
• Goodkind
• Odd Duck
• Story Hill BKC

Also, Solly’s Grille won one of the six James Beard America’s Classics Awards that year. In 2023 a few other new restaurants/chefs also were nominees:

• Birch
• Dandan
• Lupi & Iris

If you want a full list of all the restaurants that have caught the James Beard Award’s eye over the years, check out this list from Visit Milwaukee. Even Eater is noticing “MKE” as a food destination. They have listed Milwaukee as one of The Best Food Cities to Travel To in both 2020 and 2024.

If you’re planning to eat your way around the 414, might I also suggest a Fish Fry Friday at Lakefront Brewery. You see, if you’ve not been here, you might not realize Fish Fry Friday is “a thing.” It all ties into the history of Catholics moving to Milwaukee, prohibition, and access to fresh fish. If you’re looking for a fish fry, they’re all over the state of Wisconsin, and every neighborhood has its particular favorite. Mine is Mibb’s & Viv’s in Lannon which is both amazing and about as old school as it gets. However, if you’re just in town for a little while, you really need to go to the one at Lakefront because you can do the brewery tour first, then eat in their huge beer hall afterwards. It’s an experience.

Sunday Brunch is another “thing” here. Milwaukee prides itself on their bloody Marys, and there are several establishments that go above and beyond in that category. My personal favorite is Sobelman’s, where the bloodies can be as big as your head. If you like regular sized bloodies, I enjoy The Wicked Hop. However, across the street in the Third Ward you can enjoy an amazing brunch with an amazing view on the rooftop of Cafe Benelux. If you want more of a classic tavern vibe, head to Uncle Wolfie’s Breakfast Tavern.

I didn’t even get into the grilling and BBQ culture here. It’s so prevalent, the Milwaukee Brewers have made a jersey patch out of it. Most summers you’ll find local Milwaukeeans in their yards grilling anything and everything. On top of that, while it’s not Texas, there are some really good BBQ restaurants in the area. Needless to say, MKE isn’t short on good places to eat, and it’s not just McDonald’s or Big Boy anymore (although we do have one of the last Big Boys still around).

Finally, I’m just going to list some of the places my wife and I love to eat at because there really are some top mentions around here that are worth checking out.

• Bacchus (Fine Dining)
• Balistreri’s Italian-American Ristorante (Pizza)
• Café Corazón (Tacos)
• Café Hollander (Gluten Free)
• Carnevor (Steak — Ultramodern)
• Eddie Martini’s (Steak — Classic)
• Elsa’s On the Park (Classic American Fare)
• Five O’Clock Steakhouse (Steak — Supper Club Ambience)
• Flour Girl and Flame (Pizza)
• Harbor House (Seafood)
• Heaven’s Table (BBQ)
• Just Smokin’ Barbecue (BBQ)
• Kyoto (Sushi)
• Ono Kine Grindz (Hawaiian)
• Pepperpot (Jamaican)
• Prec1nct Tap & Table (Farm to Table)
• St. Paul Fish Company (Casual Seafood)
• Taqueria la Guelaguetza (Tacos)
• The Stillery (Classic Northwoods Wisconsin)
• Zócalo Food Truck Park (a little of everything)

MUSIC & CULTURE

Milwaukee has one heck of a music scene. It doesn’t garner the reputation as a cradle of a particular genre like Seattle does with grunge. It doesn’t advertise, or “do it for the gram,” as much as Chicago’s Lollapalooza, California’s Coachella, or Texas’s South by Southwest. However, Milwaukee absolutely should pop up on your radar for Summerfest. Running since the 1960s, Summerfest is one of THE largest music festivals in the world. In fact, its annual attendance is usually that of all three other previously mentioned festivals combined. Whether you love rock, rap, electronic/house music, country, R&B, pop, alternative, or oldies I promise you some of the best in each genre will be at Summerfest each year.

Nearly every major concert comes through Milwaukee because of the relatively new Fiserv Forum downtown (and even more will be here once the Iron District is complete). More recently the Harley-Davidson Homecoming concert series, which just featured Green Day and the Foo Fighters, has been turned into an annual event. Name a band, and if they’re touring, they’ll probably be here.

There’s also a thriving local music scene. You can pull up to all kinds of coffee shops, bars, various outdoor venues, and often times there are places that have live music.

Maybe you’re more of a theatre person? How about some comedy? Milwaukee has no less than 11 amazing locations in their Theatre District. You’ll find opera, ballet, the symphony, musicals, plays, and performances of all kinds. It makes for a great date night, and the schedule is usually pretty jam packed.

I’m deliberately saving the best for last…culture segment, though. Do you like art? You should see the Milwaukee Museum of Art. The building itself is a giant moving sculpture by famed architect Santiago Calatrava. Honestly, even if you’re not an art fan, it’s worth just going over to see the building that’s arguably become the crown jewel of the Milwaukee skyline. If you ARE an art fan, also be on the lookout for some of Jeremy Novy’s street koi fish paintings adorning some of the walkways around the city. Also stop over at Milwaukee’s Historic Third Ward which was named by USA Today as one of the Top Ten Best Art Districts in the United States.

The MAM is not the only museum in the area. Museums (and some would say bowling) are some of the best things to do during the winter months. I happen to enjoy the Milwaukee Public Museum, the Harley Davidson Museum, and Discovery World Science, Technology & Aquarium. America’s Black Holocaust Museum is definitely worth a visit for history buffs. You won’t leave here without feeling the impact.

I would also include the Mitchell Park Horticultural Conservatory, known locally as “The Domes.” There are plants and environments from all over the world, and you can probably get through all three domes (floral, desert, and tropical) in about two hours. It’s a great place to take the kids.

ENTERTAINMENT & CONFERENCES

I don’t know that I’d consider this under culture per se, so I made entertainment and conferences a separate entry. You see, we have this incredible conference center that’s under renovation. It’s called the Wisconsin Center (soon to be Baird Center). They do everything from auto shows, to medical conferences, to gymnastics competitions, and even an annual gaming convention. By the time the expansion is complete in 2024, you can expect even more events to come to Milwaukee. Comic Cons and industry tradeshows galore!

PARKS, TRAILS, & THE ZOO

Parks are everywhere, here. One thing I’ve noticed about Milwaukee is that when it’s warm outside, people really take advantage of it. Believe it or not, that didn’t always happen when I lived in South Florida. It’s a different mindset. Here you’ll find many families out for picnics. There’s biergartens at most parks during the summer. One of my favorites is Menomonee Park. You can take your bike along the bugline trail to get there. People love kayaking, running, hiking, and just being outdoors.

Milwaukee also has a lot of pride in its zoo. Animal enthusiasts and families alike adore the Milwaukee County Zoo, routinely ranked amongst the top 10 zoos in the United States. My father likes to tell us stories about his pet iguana, Astyanax (named for the mythological son of the Prince of Troy who was thrown over the walls of the city by Achilles’ son Neoptolemus), and how he got so big that he had to give it away to the Milwaukee County Zoo. Given that iguanas only live about 20 years, I never got to prove, or disprove, my father’s tale. Needless to say, I met plenty of iguanas when I lived in Florida.

SPORTS

When you think of the best sports cities in America, where do you think of? If Milwaukee didn’t pop into your mind, you’re missing out. Sure, we’re considered small market, but our pro and college teams routinely draw some of the top attendance numbers. Being a big sports fan, myself, I can tell you the in-game experiences I’ve had here in Milwaukee far exceed that of most other cities.

PRO SPORTS

Milwaukee is truly a Major League city. The NBA’s 2x champion Milwaukee Bucks, MLB’s 1982 AL champion Milwaukee Brewers, and (while technically not in Milwaukee) the NFL’s 13x (including 4x Super Bowl) champion Green Bay Packers all reside here. Names like Kareem Abdul-Jabbar, Oscar Robertson, Giannis Antetokounmpo, Robin Yount, Rollie Fingers, Paul Molitor, Hank Aaron, Bart Starr, Ray Nitschke, Reggie White, Brett Favre, Aaron Rodgers…and of course Vince Lombardi have all helped to put Milwaukee and Wisconsin professional sports teams on the map. This city’s love affair with its sports teams is nothing to sneeze at. Fan support during the “lean years” has been good, but when there’s a winner in town, EVERYONE rallies around them.

There’s a reason that Antetokounmpo, a 2x NBA MVP and 2021 NBA champion, has his own mural painted on the side of the 600 East building on Wisconsin Avenue. Milwaukee is nothing if not community-centric. If you do right by us, we’ll do right by you. Antetokounmpo has exemplified everything Milwaukee is about, both on and off the court, and artist Mauricio Ramirez memorialized him for it. If you’re in town, and you’re a sports fan, definitely be sure to take a photo in front of it. While you’re at it, depending on the season, you should really check out the Fiserv Forum, American Family Field, or historic Lambeau Field. I would also include the AHL’s Milwaukee Admirals and the Major Arena Soccer League’s Milwaukee Wave who have both garnered much success in their long tenures in Brew City.

COLLEGE TEAMS

I mentioned both my parents were alumni of UW-Madison. It’s only a 90-minute drive from Milwaukee, and the Badgers are probably the most popular school in the state. The Badgers football program has 3 Rose Bowl championships, the men’s basketball program has 4 Final Four appearances, and their men’s hockey program has 6 National Championships. However, their most successful program might be their women’s ice hockey team who has 7 National Championships…the most in the country. If you have the time to visit Madison to catch a game, I would absolutely recommend it. You can’t beat Jump Around before the fourth quarter, and the campus is often ranked among one of the most beautiful college campuses.

Knowing all of that, don’t forget that Milwaukee’s top college sports program is the Marquette University men’s basketball team. It’s right in the downtown area, and they’re 4x Final Four participants as well as the 1977 NCAA Champions. Marquette is arguably a college basketball “blue blood” with names like Dwyane Wade, Doc Rivers, and Jimmy Butler having played here as well as Al McGuire and Shaka Smart having coached here.

By the way, I should mention tailgating is an art form here (even when it’s cold). Yes, NFL and college football are known for having some pretty epic tailgates, but here in Milwaukee we tailgate for almost everything. If you’re going to a Brewers game (mentioned above), get there early and be ready to tailgate. If you’re going to a basketball game, you might want to “pregame” at one of the nearby bars (which I’ll talk about below). Milwaukee knows how to throw a party, and here sports and parties absolutely go together.

GOLF

Whether you love to watch golf or play golf, there’s plenty here for you. The site of the 2021 Ryder Cup, Whistling Straits is a PGA golf course just over an hour away. While it’s absolutely incredible, you don’t have to go that far to play golf in Milwaukee. There are 13 courses in the Milwaukee County Golf system. That includes Brown Deer Park, home of the former Greater Milwaukee Open, where Tiger Woods officially made his professional debut in 1996. If that’s not enough for you, Golf Digest named the state of Wisconsin the top state for public golf courses in 2024!

RECREATIONAL SPORTS

Maybe you’re more of a participant than a spectator, but you’re looking for something other than golf. Great news, there’s a huge pickleball scene growing in Milwaukee, and outside of that…well, take your pick. Softball, baseball, basketball, tennis, flag football, whatever you want is probably over at the Kinnickinnic Sports Center. If you’re more a winter sports person, there’s ice hockey, figure skating, and curling over at the Petit Center.

Bowling is a pretty big deal here. It always has been. I mean, I even mentioned above that my parents met at a bowling alley. So, I guess thanks to bowling, I exist. Needless to say, if you’re a bowler, there are plenty of alleys, and leagues for all skill levels, nearby.

The fertile and competitive Milwaukee sports scene has turned out many a star athlete including Tyler Herro, J.J. Watt, Joe Thomas, Olympian Gwen Jorgensen, Terry Porter, etc. But hey, if you just want to participate casually, you can see there’s plenty of that, too!

BREWERIES, DISTILLERIES, & BARS

They don’t call Milwaukee “Brew City” for nothing. Actually, Milwaukee has a bunch of nicknames including “Cream City” because of the cream-colored bricks you’ll see everywhere. If you want to see all the other nicknames, just click the link to Visit Milwaukee’s extensive list. Brew City is probably the most ubiquitous, though, because beer is a part of Milwaukee’s history. Many Germans settled here in the 1840s, and you better believe they brought their love of beer with them. Schlitz, Blatz, Pabst, and Miller were all born here. That’s why old TV shows like Laverne & Shirley used to feature characters working in a fictitious brewery. Some of those OG macrobreweries like Miller Brewing Co. are certainly still around, and if you’re into the history of beer, you might want to check out the Pabst Best Place Tour. However, there’s a thriving craft beer scene in Milwaukee with a plethora of breweries you’ll want to try because some of them you just can’t get out of state!

These are the breweries I’ve been to over the last two years. I can’t possibly list every brewery in the area because there are a LOT. Seriously. We love beer here.

• 1840 Brewing Company
• Broken Bat Brewery
• Central Waters Brewing
• City Lights Brewing
• Eagle Park Brewing Company
• Foxtown Brewing
• Gathering Place Brewing Company
• Good City Brewing
• Hacienda Beer Co.
• Lakefront Brewery
• MKE Brewing Co.
• MobCraft Beer, Inc.
• Sprecher Brewing Company
• Third Space Brewing

…but Ryan, you forgot XYZ brewery! No…no, I didn’t. I just can’t list them all. People have tried to make t-shirts with all the breweries on them, and there’s always new ones popping up making it impossible to keep up to date. If you pick a neighborhood in Milwaukee, there’s probably a craft brewery…and it’s probably awesome. Tour as many as you can, but if you only have time to stop at one place, pick Lakefront. I mentioned them above when I spoke about Fish Fry Friday. They’re one of the OGs of craft beer here, and they’re really good.

Are you a beer history buff? You’re in luck. There’s a Museum of Beer & Brewing under construction at the Lincoln Warehouse complete with three breweries (and one distillery) joining them: Component Brewing Co., Torzala Brewing Co., New Barons Brewing Cooperative, and Twisted Path Distillery. In time, the Museum of Beer & Brewing might make for a great kickoff location for a “Beer Run” similar to Louisville, Kentucky’s “Bourbon Trail.”

I should also mention…those Germans that moved here over 150 years ago, well they brought Oktoberfest with them. In October the weather’s cool, but not cold. It’s a great time to do some beer tasting, and then you can throw on your lederhosen, dance to some polka, and celebrate Oktoberfest!

DISTILLERIES

If whiskey is more your speed, don’t pass up the Great Lakes Distillery. They have a lot to choose from, including whiskey, vodka, rum, gin, absinthe, and brandy (which is important because in Wisconsin they make an old fashioned with brandy). In true Milwaukee fashion, there’s always another place to drink. That goes for distilleries as well. While Great Lakes is probably the most famous, you might want to check out these as well:

• Central Standard Craft Distilling
• Eagle Park Distilling
• Handen Distillery

You’ll notice Eagle Park Brewing Co. and Eagle Park Distilling is the same location. So, if you’re looking to kill two birds with one stone (their logo has a bird on it, so it’s funny to me) Eagle Park might be your best bet.

BARS

Okay Ryan, tell me all the good bars in Milwaukee. Yeah, no. There’s bars everywhere. If you want the classics, stop at Wolski’s. All about “mixology?” Stop at Bryant’s. Prefer a speakeasy? You’ll like Mosler’s Vault. If you like kitschy & spy themed you’ll want to check out Safe House. There’s townie bars, college bars, rooftop bars, hotel bars, etc. Even bars you can pedal around the city on! There are so many bars that you have to decide what segment you want to experience before you even go. If you go down to the Deer District near Fiserv Forum, there’s a bunch that are fun. I like Deer Camp, and Steny’s is great, too. If you’re looking for something higher end, definitely check out The Outsider. The Third Ward is very popular with locals and tourists alike. There’s always new places to explore, so here’s a guide to some of the bars that recently opened. You can really go down a rabbit hole when it comes to bars. Back in 2015, Bon Appetit magazine named Milwaukee the Best Bar Town in America for a reason. We know how to have fun!

HUNTING, FISHING, CAMPING, HIKING, AGRICULTURE, & NATURE

The great outdoors is right here in Milwaukee! Did you know we have a beach? It’s not like the beaches in Miami or Puerto Rico, but we have a beach! There really are so many outdoor activities you can do, you wouldn’t be able to attempt them all in one trip.

HUNTING

I will preface this by saying I’m not a hunter. I don’t know very much about it. I can tell you Wisconsin is a hunter’s paradise. You can hunt deer, turkey, waterfowl, elk, bears, grouse, etc. Check with the Wisconsin Department of Natural Resources to see when the various hunting seasons are, and make sure you have a valid hunting license. There are even hunting competitions both by hunting rifle and by archery.

FISHING

Speaking of competitions, there’s plenty of fishing competitions in the Milwaukee area, too. Wisconsin has always been a great place to fish for trout, largemouth bass, smallmouth bass, catfish, sturgeon, musky, walleye, perch, salmon, etc. You can go out on a boat on Lake Michigan or you can hit up the shoreline & rivers in the area. It’s great to take the kids like my grandfather used to take me. We’d catch trout, and then he’d find a local smoke house so we’d have smoked fish for quite a while. You can even create your own fish fry Friday.

While I’ve never gone, come winter, there are excellent ice fishing locations, too! You might have to drive an hour, or so, outside of Milwaukee, but if you’re an ice fishing afficionado, I’m sure that’s not a problem.

CAMPING

There are so many campgrounds around Milwaukee, but as you might expect it’s so popular that you’ll need to make reservations in advance. Standard camping, group camping, backpack camping, boat-in camping, equestrian camping, and winter camping are all options. Thankfully, the Wisconsin Department of Natural Resources has a Find a Park feature that allows you to find the campgrounds that best fit your needs.

HIKING & BIKING

I mentioned the bugline earlier, and I also highlighted the Find a Park feature on the Wisconsin Department of Natural Resources website. Those are great for hiking and biking, too. There really are a lot of trails to choose from, and there are different skill level options, too. Feel free to bring the whole family, or feel free to challenge yourself.

AGRICULTURE

Agriculture is a major part of Wisconsin industry. It’s no surprise given that we’re “America’s Dairyland” (there’s another one of those nicknames). Dairy farms aren’t the only types of farms in the state. There’s apples, oats, potatoes, carrots, tart cherries, maple syrup, sweet corn, cranberries, and ginseng to name a few. Some of these places will let you gain a new perspective on agriculture. Here are some of my favorites, including a place you can get a Wisconsin-favorite treat…cheese curds:

• Basse’s Taste of Country
• Clock Shadow Creamery
• Door County Cherries
• Green Meadows Petting Farm & Corn Maze
• Hinchley’s Dairy Farm
• Lannon Sunflower Farm
• Peck and Bushel Fruit Company

LAKE HOUSES

Given the vast number of lakes in Wisconsin, it’s no surprise that there are a good number of families that have lake houses here. One of the favorite pastimes of Milwaukee summers is to get out to one of the various lakes and relax. Even if you don’t have a lake house, or you don’t have a friend with a lake house, there’s ways you can get out and enjoy the fun, too! You’ll most likely want to head over by Pewaukee Lake, Lake Geneva, Lake Beulah, or just jump on Vrbo and see what’s available to rent. You can always head up to Door County (the Cape Cod of the Midwest). There are plenty of lake houses up there to pair with the wineries and state parks.

PHOTOGRAPHY

Some cities are just more photogenic than others, and I feel like Milwaukee grows more photogenic by the year. With new buildings going up all the time, the historic buildings still around, and the architecture, there’s so many different things (and ways) to take great photos of here. There are a handful of great photographers that have really taken advantage of what Milwaukee has to offer.; However, you, too can get out your SLR (or your cell phone) and go take some great pictures! There are several different photography tours that feature different options like social media or general walking tours. If you’re of the drone photography persuasion, there are all kinds of parks you can set up at and let your drone do the work for you. Here are some of the better photographers in the area to give you some inspiration:

• Brandon Dart
• Mike DeSisti
• Steve Stango
• Nate Vomhof

GAMBLING

I wouldn’t consider myself much of a gambler, however, I did once go to Las Vegas for a bachelor party, bet $100 on the 2010 Green Bay Packers to win the Super Bowl at 10–1 odds, and that paid off nicely! You no longer have to go to Vegas to bet on sports, though, because Potawatomi has opened the first sportsbook in Wisconsin. In fact, Potawatomi (pronounced POT-uh-WATT-oh-me) is a gaming paradise complete with a casino, a hotel, restaurants, and various shows. It’s owned by the Forest County Potawatomi Community and has been a Milwaukee staple since the early 1990s. Pull up at a table and try your hand at some poker or blackjack while you’re in town.

HISTORY & HAUNTED PLACES

Milwaukee has been around for nearly 200 years, so you can pretty much bet on seeing a lot of historical landmarks that are still around. There’s the Basilica of Saint Josaphat, the Central Library, the Federal Building & Courthouse, the Lloyd Smith House, and the Pabst Mansion just to name a few. You can always check out the Milwaukee County Historical Society for information on other areas that you can tour.

The historical location I didn’t mention in the previous paragraph is the Pfister Hotel. The reason is because the Pfister gets a special designation given that history and the paranormal intersect here. It was built in 1893, and it’s still an excellent, luxurious place to stay today. In fact, the majority of visiting celebrities in town for shows, and the teams that are in town to play the Milwaukee Brewers, often stay here. If you’re a fan of ghost stories, then maybe the Pfister is up your alley. US Ghost Adventures offers a ghost tour that lets you stop at the Pfister, and other sites, to see if you can encounter the supernatural.

WELLNESS & RELAXATION

Maybe relaxation is your goal, instead. Well, the Pfister may still be your go-to. Their Well Spa + Relaxation is one of the best places in town that you can pamper yourself. Neroli is a non-hotel based salon & spa that you can visit if you’re not staying in the Pfister. If you’re looking for the full resort experience, the Grand Geneva is over by Lake Geneva, and they cater to everything from couples to families.

PROXIMITY TO EVERYTHING ELSE

This last component I’m going to mention is something people don’t often think about when it comes to Milwaukee. You have so much here, but you have access to so much more. Look how easy it is to connect to some of the other great places in the region…

• 🚗 1hr. 10 min. to one of the best college towns in the country, Madison
• 🚗 1 hr. 30 min. to one of the largest cities in the country, Chicago
• 🚗 3 hrs. to the Field of Dreams movie site in Iowa
• 🚗 4 hrs. 30 min. to Indianapolis, home of the Indy 500
• 🚗 5 hrs. to Minneapolis
• 🚗 5 hrs. 30 min. to St. Louis
• 🚗 6 hrs. to Mackinac Island, the fudge capital of the United States
• 🚗 6 hrs. to Detroit
• 🚗 6 hrs. 30 min. to Cincinnati/Kentucky to visit the bourbon trail and the Kentucky Derby

Plus, if you ever thought about staying, there’s great schools, the cost of living is really good, and like I said in the title…there really is something for everyone!

Ryan’s Ideal Milwaukee Trip

Everyone has a different idea of what makes a great trip. For us, I know that I usually want to check out a few historical sites, my wife wants to eat at some foodie destinations, I’d love to get another ballpark checked off my bucket list, and we need to ensure we go somewhere my young son would enjoy. So, here’s how I would put together a 5-day trip to Milwaukee. (Also, if you’re interested, I have put together my own Google Maps 📍 Milwaukee Recommendations list that you can follow if you’d like to use that to build your trip.)

THURSDAY

• Land at General Mitchell Airport
• Head to the hotel to get settled

1. Pfister if you want something high end & historic

2. Kimpton Journeyman if you’re in on business

3. The Trade if you want to be right in the thick of it all

4. Kinn Guesthouse if you’re a boutique kind of person

• Stop at the Milwaukee Public Market near the Third Ward. Great spot to grab a quick bite to eat from a plethora of Milwaukee-area restaurants all in one place. There’s a bit of shopping in there as well. You can walk over to the Third Ward and see what’s happening and/or get around downtown to get the lay of the land.
• Head over to the Milwaukee Riverwalk to get your steps in, and then take a photo with the famed “Bronze Fonz.”
• If there’s a Brewers or Bucks game that night, I’d go to that (be ready to tailgate at AmFam Field). If not, see what shows are in town in the theatre district.
• Dinner option, if you’re still hungry, Flour Girl & Flame pizza to take back to the hotel room and relax.

FRIDAY

• Friday I’d probably sleep in a little bit, otherwise, get up and go for a run around the city.
• Stop for morning coffee at one of the Colectivo locations. If you love a TON of caffeine, get their nitro cold brew.
• If it’s State Fair or Summerfest season, you’re headed there by now. If it’s not, then, since I have a kid, he’ll probably want to go to either the Zoo or the Milwaukee Public Museum.
• Lunch time, don’t pass up on Kopp’s Frozen Custard. You’ll have to drive or uber. Amazing burgers, and you can load the family up on sweet treats.
• If it’s nice out, burn off some of the frozen custard by kayaking over by the Hoan Bridge. Enjoy the sun and the water.
• For dinner, it’s Friday, so I’m doing fish fry Friday at Lakefront Brewery. Get there early, do the tour (book ahead), then stay in the beer hall and have fried cod & listen to live music.

SATURDAY

• Breakfast at Comet Cafe or Allie Boy’s
• Saturday is a good spa day if you’re looking to relax
• Another option would be to hit up Menomonee Park. There’s playgrounds and places to picnic. There’s a mini beach there, too. You could also head over to the lakeshore and relax over by Bradford Beach.
• Lunch at Story Hill BKC (James Beard Nominee)
• Depending on the weather, this might be a good time to go see the Mitchell Park Conservatory or the Milwaukee Art Museum. If it’s nice out, this is a good time to “free space” it and just see where the day takes you because when it’s nice out, the city comes alive.
• Dinner time will be something upscale on Saturday. I’ll add in James Beard award winner, The Diplomat

SUNDAY

• Sundays are for brunch. It’s a thing here in Milwaukee, so I would either go to Sobelman’s for a bloody Mary the size of my head, or I’d book the bloody Mary tour & check out several locations in one day.
• Depending on how long you’re out brunching (some people make this an all-day event), you might want to check out one of the boat tours.
• Shopping is usually on most people’s lists, so I’ll put that here since this is probably a time to get some of that in.
• I know my kid likes video games, so this would be a good time to introduce him to Up Down, where he can check out old school arcade games! There aren’t many places like that left. There are also a bunch of escape rooms around here that are fun to do!
• Still hungry? If you have to get in another good dinner before your travel day, check out St. Paul Fish Company or Twisted Fisherman for seafood.

MONDAY

• Monday is usually a travel day. So, if you’re headed out via General Mitchell Airport, just know you can pick up a case of Spotted Cow to take home with you as a “souvenir.”
• If you’re extending your trip, you can easily make a Milwaukee-Chicago two-fer in one week.

Ultimately, you can put together whatever kind of trip works best for you. There are excellent resources out there, such as Visit Milwaukee’s Official Visitors Guide. Plus, you can always just ask a local. We’re friendly, and always willing to help. I hope you’ll come see why Milwaukee isn’t a hidden gem anymore. It’s really arrived.

About the Author

Ryan Mackman is the Director of Planning and Market Research for the Medical College of Wisconsin. He hopes to someday bring an NHL team to Brew City, is a Green Bay Packers shareholder, and lives in the greater Milwaukee area with his wife, son, Congo African Grey parrot, and cat. If you’d like to contact him about Milwaukee, you can reach him on Twitter or just wait for him to show up at Kopp’s Frozen Custard every so often.

(Originally published on May 20, 2021 at www.salienthealthcare.com.)

If Hollywood can revive old movies or create sequels about stories from years ago, like 1986’s Top Gun, then I can revive some old topics that are still relevant today. Back in 2017, Amy Kotch wrote a Salient Healthcare blog on Patient Engagement. While she certainly highlighted a few key points, such as the value of the Annual Wellness Visit and developing a better physician-patient relationship, there are out-of-the-box ideas that, while intangible, can go a long way towards boosting patient satisfaction, leading right into patient engagement. Yes, you want good remarks on your Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which is going to make up nearly 1/3 of quality reporting, however, part of the key to that is genuinely giving your beneficiaries a reason to be happy (which is a relatively new mindset in healthcare). It’s also important to note that patient satisfaction can boost attribution and market share, and I will actually be discussing both of those topics in the next month. Keep an eye out!

EXTRAORDINARY SENSE OF WELLBEING

When I was working for a Level 3 Patient Centered Medical Home in West Palm Beach, my then-Medical Director often referred to it as, “Creating an extraordinary sense of wellbeing.” In my early years I remember thinking, “What does that have to do with healthcare?” However, the longer I have been in the industry, I’ve come to realize that it’s one of the big keys to patient satisfaction.

Case in point, there have been several studies on hospital patient satisfaction linked to the food they receive during their stay. Not the care they receive. Not the bedside manner of the doctors and nurses. The food! Now, many of us have seen that hospitals are beginning to look more and more like five-star hotels over the last decade, and that’s not a coincidence. It’s because patient satisfaction seems to have more to do with the emotional wellbeing of the patient as opposed to just the physical wellbeing that is being treated.

As an Accountable Care Organization (ACO) it’s important that you continue to build that physician-patient relationship because that connection may be what gets each beneficiary to call their PCP over heading to the Emergency Room. Unfortunately, nobody ever talks about how to actually build that relationship so that it falls under the category of successful patient engagement. Below are some examples of thinking outside-the-box in order to make patient engagement a daily priority.

CUSTOMER SERVICE

As soon as you saw customer service, I’m sure you thought, “They’re patients, not customers.” In this instance you can actually be right and still be wrong. In most instances, medical practices and hospitals forget that most of their patients are going to be in bad moods when they come into the office. Nobody wants to go to the doctor. Our medical director challenged us to actually make people want to go to the doctor, and we did.

We brought in a customer service consultant from a local hotel, and over several days we put groups of our employees (front desk, scheduling, billing, referrals, phlebotomy, etc.) through four-hour customer service training. The idea was to make each patient feel special the way customers feel special when they walk into a hotel. It’s about the experience instead of just about getting in and out. From the moment a patient calls to speak with a scheduler, checks in at the front desk, is brought back to the exam room by a medical assistant, is seen by their provider, and checks out while simultaneously scheduling a follow-up appointment, the customer service aspect has to come first. In my experience, the extra TLC did wonders for patients upset about long wait times to see their provider. It made them feel appreciated. It made them want to recommend the practice to their friends, and ultimately it made them feel like they were part of the family.

Now you don’t have to necessarily hire a hotel concierge consultant, but there are other courses out there that teach customer service skills. Chick-Fil-A is notorious for their superior customer service, and whether-or-not you think they have the best chicken sandwich in the country, people will clearly stand in line for quite a while just because they’re treated as guests instead of customers. The key is, spend the time teaching your staff to appreciate your patients, and they’ll appreciate you when it comes time to fill out the CAHPS survey, schedule an appointment, and recommend your services to the greater community.

I SCREAM, YOU SCREAM, WE ALL SCREAM FOR ICE CREAM

What do you get when you hand 150 senior citizens two scoops of vanilla ice cream? If you said diabetes, you’re not wrong, but the answer we were looking for here is happiness. South Florida’s senior population was a bigger challenge to get engaged. We found that while our younger population appreciated just being taken care of, the seniors really wanted to connect to the providers. It’s not surprising when we know that loneliness and social isolation among seniors is a major health threat. Getting them to gather at your medical office actually gives them a place to feel connected.

Once per quarter I would block out appointments for the last hour of the day, and then invite all of our seniors to attend an ice cream social. It wasn’t particularly expensive, and as an added bonus I had our providers either serve the ice cream or mingle with patients. You play a little music, and let everyone have fun. It’s low-cost, easy setup, and augmented our physician-patient relationships exponentially. The key is that you’ve turned your medical practice into a sometime-social attraction. Years ago, this would have been unheard of, but today it’s an outside-the-box solution to the patient satisfaction/engagement challenge.

WHAT ELSE CAN I DO?

Thinking outside-the-box doesn’t mean you have to do anything crazy. It’s just little things that might make a patient’s already challenging life just a bit easier. Remember, they don’t know how to navigate the healthcare system like you do. They may not even know how to navigate your practice like you do. Maybe consider hiring a patient advocate whose job is to work closely with those difficult patients that always seem to be upset. The advocate can move easier through your operational hierarchy because they know how everything runs and who the key personnel are. In some cases, it’s better than adding an extra scheduler because your scheduling team is always pressed for time to move on to the next call. The patient advocate’s role is specifically not to be in a rush.

You don’t’ have to get too high-tech, or too expensive. Just get personal. Get human and watch your CAHPS and quality scores hit the ceiling because your patients actually want to be a part of what you’re putting together.

RESOURCES

• Centers for Disease Control and Prevention. (2021, April 29). Loneliness and Social Isolation Linked to Serious Health Conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html.
• Dall’Oglio, I., Nicolò, R., Di Ciommo, V., Bianchi, N., Ciliento, G., Gawronski, O., Pomponi, M., Roberti, M., Tiozzo, E., & Raponi, M. (2015, January 27). A systematic review of hospital foodservice patient satisfaction studies. Journal of the Academy of Nutrition and Dietetics. https://pubmed.ncbi.nlm.nih.gov/25634093/.
• United Healthcare. (2020, November 10). What are the CAHPS® and HOS surveys and why do they matter? CAHPS/HOS Overview. https://www.uhcprovider.com/content/dam/provider/docs/public/reports/cahps-hos/CAHPS-HOS-Overview.pdf.
• Weed, J. (2016, August 1). With Room Service and More, Hospitals Borrow From Hotels. The New York Times. https://www.nytimes.com/2016/08/02/business/making-hospitals-more-like-hotels.html.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Originally published at https://www.linkedin.com.

(Originally published on May 20, 2021 at www.salienthealthcare.com.)

I honestly can’t believe we’re almost halfway through the year, and we’ve had, now, two more NAACOS virtual conferences thus far. The first Bootcamp, and NAACOS Spring 2021 of which Salient Healthcare was a part of.

WINTER BOOTCAMP 2021

Bootcamp is always an enjoyable deeper dive into value-based care best practices. Our own Amy Kotch and Maria Nikol joined Rob Mechanic and Jennifer Perloff from the Institute of Accountable Care in presenting “ How to Leverage Data to Promote Continuous Process Improvement “ in late January. As value-based care continues to evolve, much of the healthcare community is realizing that without the proper data, they just won’t be prepared to take on risk. The reality is that the well-received seminar perfectly set-up Amy and Maria’s presentation for NAACOS Spring 2021 at the end of April. If you’re interested in looking at the slide deck, simply click on the presentation title above.

NAACOS SPRING 2021

In late April, Amy and Maria teamed up again, but this time to present “ Diving Deeper Into Financial and Utilization Impacts: An ACO Cohort Study of COVID-19 Episodes.” It was one of many great seminars presented by NAACOS, but I would be remiss not to praise our team’s deep look at how COVID-19 affected many of our clients here at Salient Healthcare. We were able to evaluate pre and post-pandemic impacts on the total cost of care, acute care, post-acute care, telehealth utilization, and preventive services in relation to quality metrics. Salient Healthcare was also able to review the CMS policy changes, and the impacts of these policy changes, on provider organization with regards to future performance. Finally, the team discussed shared savings distributions, preparing for life after the pandemic, and planning to move to risk. While I found it very informative, you don’t have to take my word for it. Simply click the title above to watch the recorded session on our YouTube channel.

Now enough “me, me, me” talk, and let me touch on a few other great seminars. The opening plenary is always a treat, and this Spring we had Liz Fowler, Director of the Center for Medicare & Medicaid Innovation at CMS. Through her entire presentation, one of the areas that I thought she really hit on was that, “we need to do better with multi-payer alignment.” Right now there are so many different contracts with different rules and regulations that it makes it really difficult on Accountable Care Organizations (ACOs), Direct Contracting Entities (DCEs), and Clinically Integrated Networks (CINs) to actually succeed at value-based care. It’s hard to believe we’re still less than 10 years from the start of the Medicare Shared Savings Program (MSSP), which means technically we’re still on the ground floor. There are growing pains associated with that, but the speed at which healthcare is evolving is making it challenging to learn on the fly as many provider organizations are doing.

That thought kind of leads into what Dr. Mark McClellan, Director of the Duke Margolis Center for Health Policy, spoke about in his seminar, titled “Value-Based Care’s Future Post COVID.” Dr. McClellan is always a worthwhile listen, and he stated that it’s important that we don’t “lose sight of the long-term reform goals. We need a shared commitment in order to succeed.” What it comes down to is that the ever-evolving world of value-based care is causing a lot of people to look for short-term gains. As mentioned, we’re not even 10 years in, and we need to keep our eyes on the horizon. This is a marathon, not a sprint.

I also appreciated Jennifer Moore, Jeanette Flood, Mark Schario, and Bob Trinh ‘s discussion titled, “Reach for the Stars: Driving Success in Medicare Advantage Agreements.” This presentation was a collaboration between Maine Health ACO, Delaware Valley ACO, University Hospitals, and The Villages Health. This was arguably one of the best presentations that I’ve heard at NAACOS. The group discussed all of the challenges they’ve faced and/or overcome as they, like many provider organizations, have begun to take on more Medicare Advantage contracts and other value based commercial contracts. They provided real, tangible considerations that an organization should consider when engaging with commercial payers in contract negotiations. My main takeaway from the seminar is that, “Ingesting payer data, finding outliers and trends, and having ad-hoc capabilities are keys to driving success when contracting with MA plans.” We are hearing similar themes across other population health conferences-increased need for a performance management solution that can handle multi-payer contracts. I highly recommend downloading the slides to use as a checklist of items to negotiate.

The Salient team thoroughly enjoyed NAACOS Spring 2021. It was a worthwhile two weeks of virtual learning, and we look forward to NAACOS Fall 2021 in Washington, DC where I’m told this time it’s finally in-person! Virtual conferences have their positive points, but nothing replaces the in-person environment. Sharing knowledge is a key piece of every conference, however, I would argue that when the networking component is lost (which frequently happens in a virtual environment) you’re only receiving a fraction of the value of the event. Whether you’re a provider organization or a business partner, it’s important to get to know the others in our industry because relationships absolutely matter in healthcare. On that note, I look forward to getting to know some of you, and reconnecting with everyone else, in the near future.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Originally published at https://www.linkedin.com.

(Originally published on November 16–23, 2020 at www.salienthealthcare.com.)

Since the Fall 2020 conference season was quite a busy one, I have combined all four blogs into one LinkedIn article that includes NAACOS, HLTH, FLAACOS, and APG Colloquium.

NAACOS FALL 2020

Time flies, right? It was just this past summer that we were attending NAACOS Live Spring 2020, and only a few months later we were into NAACOS Fall 2020. A lot of that is because the Spring edition occurred later than originally planned, so it created a bit of short “offseason” so to speak. This fall is the beginning of what we know to be conference season in which there’s a slew of conferences to attend; this year they’re all virtual though. Some of the same speakers were featured during the fall edition. NAACOS CEO Clif Gaus always gives us a great state of where value-based care stands, and Dr. Don Berwick gave a more political speech than in past events when discussing “Transforming the Healthcare System.”

If you asked me what my favorite presentations were this year, I’d be lying if I didn’t toot my own horn. My colleague Maria Nikol and I were fortunate to be able to present “Managing Performance Across Payers: Getting Different Populations on the Same Page” during Week 1, Day 2. We really appreciate Lacey Wattles from Rocky Mountain Accountable Health Network and Dan Bailey from ProHealth Solutions ACO for providing us their use cases. If you click the link attached to the title, and have access to NAACOS, you’ll be able to watch the recording. The presentation is a proud moment for us at Salient because we were able to showcase how complicated it is to bring in data from Medicare, Medicare Advantage, Medicaid, commercial insurance, etc. and get it all into one solution. Both ACO’s use cases showed how the Salient solution was able to help them get a more apples-to-apples comparison of their populations, and fortunately many of the Salient ACOs achieved shared savings this year partly because of this.

Maria also joined Travis Broome, Aledade’s Senior Vice President for Policy & Economics, and Kent Locklear, LightBeam Health’s Chief Medical Officer, to discuss “ONC Rules on Data Sharing.” The focus was how the Office of the National Coordinator for Health Information Technology’s final rule establishes a secure, standards-based application programming interface (API) requirement to support patient access and control of their electronic health information. For those who have been closely following all of the interoperability talk, APIs are the foundation of everything interoperability-related. Due to this new rule, patients will be able to securely and easily obtain, and use, their electronic health information from their provider’s medical record for free using smartphone apps much like you currently can monitor your own secure bank account.

Healthcare data, the usual where are we headed, what happens after COVID-19, and policy updates were all consistent topics through much of NAACOS Fall 2020. More than anything, I would say the fall iteration of this conference picked up right where spring left off. ACOs are trying to adjust following the pandemic, rule changes and adjustments require more flexibility on behalf of ACOs and their teams, and everyone wants more data. There can never be enough data. The downside to virtual conferences, of course, is that you lose some of the opportunity to network. Big thanks to Prime West ACO’s Sakina Pasha for setting up a few virtual happy hours. They were casual, but certainly effective in bringing back the “conference feel” that we all enjoy.

Hopefully by next spring we’ll be back to in-person events. NAACOS Spring 2021 is scheduled for April 26th through 28th in Baltimore, MD and Fall 2020 is scheduled for October 6th through 8th in Washington, DC. If you’re interested in seeing what one of the best national conferences in value-based care is all about, you can visit their website at www.naacos.com.

HLTH VRTL 2020

Fresh off the first leg of conference season with NAACOS Fall 2020, the Salient Healthcare team became first timers at a relatively new healthcare conference: HLTH. Every year we evaluate what conferences we want to be a part of, and lately it’s getting tougher and tougher to decide because there are so many (which are also all virtual this year). In 2018 and 2019 we attended HiMSS in Orlando, FL, but this year we opted for HLTH when HiMSS was cancelled due to the COVID-19 pandemic.

The great thing about HLTH is it’s geared more towards what Salient Healthcare is about. New healthcare ventures, interoperability, larger healthcare networks, and really the future of what healthcare is becoming. While only three years old, the HLTH conference has quickly become a known name in the healthcare conference circuit right alongside mainstays like Rise and MGMA.

Our team had the opportunity to speak with executives and other bright minds from major companies including Wal-Mart, Ohio State Wexner Medical Center, Fresenius Medical Care, and UC Health. As far as the seminars, over the course of the five days, I would have to say the various presentations on emerging technologies were enjoyable. I also think they put on a great effort to include value-based care with “A Push Into Value-Based Care” featuring Dr. Farzad Mostashari and Timothy Ferris in which they debated which was better: hospital-led ACOs or independent physician-led ACOs.

Mr. Ferris made a valid point that we look at healthcare as a marketplace, but from a global perspective, “The application of market economics to healthcare doesn’t always work because there are a lot of pieces of healthcare that do look like markets, but there’s also a lot of pieces of healthcare that look like utilities. Particularly the capital-intensive sides of it.” Therefore, even though many have been succeeding in value-based contracts, we’re using that pressure that comes from those contracts to reallocate capital that benefits the system overall. That’s what generates the benefit for the patients. It’s going to require continual reinvestment into the system over time in order to really keep value-based care going. Mr. Ferris continues to pontificate on the motivations of healthcare executives because, “If you are in business to maximize revenue, then you’ll stay away from value-based contracts, and you’re minimize the extent to which you’re integrating yourself with the local community to provide an integrated delivery system.” Consider that a calling out of sorts to those who got into healthcare just for the financial benefits. If we want to fix our healthcare system, that can’t be the only motivation.

Other topics of note included “How to Operationalize Remote Patient Monitoring” which was an invite-only event, Aneesh Chopra’s “The Era of Health Information Fiduciaries,” and a great discussion on the value of women in leadership positions in healthcare by Dr. Nicole Fisher and Terry Stone. My takeaway from Dr. Fisher and Ms. Stone’s conversation was that, “We don’t have a gender problem. We have a leadership problem.” Organizations are trying to find ways to get women into more leadership positions, but the progress has been slow. Per the seminar, it’s possible that part of the reason for the sluggishness may be that each gender has a different idea of “what good looks like.” Dr. Fisher and Ms. Stone mention that “good leadership” is a subjective term, and each gender prioritizes different traits with regards to what leadership consists of. Healthcare, and certainly value-based care, has a lot of women among our ranks, and I really hope to see even more female leadership going forward. Personally, I’m proud to have several female leaders on my team, and I think they each have excellent leadership skills.

The biggest challenge with HLTH is because it’s so massive, you really have to curate your own agenda ahead of time. If you just try to show up and watch everything, you’ll be booked solid from morning until late evening trying to hear everything. That means you’d miss out on some of the network opportunities that HLTH provides. It was definitely a positive experience, and I’d love the opportunity to head to Las Vegas, NV and see what it’s all about in person. I think you’ll start to see more value-based care woven into the agenda, and I would love for the opportunity to be able to speak on behalf of that subject.

If you’re looking for healthcare conferences to attend in the future, I think it’s safe to say that at this point HLTH should absolutely be on your radar. Since I suspect we’ll be back, we hope to see you there!

FLAACOS 2020

Another round of virtual conferences in the books! This week was especially tough in that there were actually three different population health-related conferences going on at exactly the same time. I, along with my team, had to split up a few responsibilities to make sure everything was covered. That being said, the Florida Association of ACOs (FLAACOs) has always been a favorite conference of mine. FLAACOs has gradually gone a little bit more national as of late, but given that I live in West Palm Beach, this conference usually gives me the opportunity to speak with experts in my industry right in my own back yard.

This year my colleague Maria Nikol and I, along with Kelly Conroy of Pinnacle Healthcare Consulting, teamed up to present “Managing Performance Across Payers on One Platform: Dream or Reality?” Given that Kelly has over 30 years of healthcare finance and management experience, including starting the first Medicare ACO in the United States, her perspective is always appreciated. She’s presented with other members of my team at other conferences, and we were glad to have her with us this week. Also, special thanks to Accountable Care Options ACO’s CEO Rich Lucibella for a great introduction.

We know, and have experienced, the challenges that ACOs, especially in Florida, face in trying to manage all of their data. There are so many uses, such as trying to assess the quality of care you’re providing, interpreting your ER readmission rates, and ensuring you’re not losing beneficiaries to plurality. However, there are other important data uses that aren’t often spoken about. How about payer contract negotiation or providing insights to your Joint Operating Committees? Finally, there’s also planning for potential unforeseen circumstances- and we know this more than ever due to COVID. Data gives you the ins and outs, the trends, and the predictive capabilities so that you’re always in a position of strength when making important decisions. We covered that and more, and if you’d like to watch the replay of our presentation, simply click here. Keep in mind, you’ll probably have to register with FLAACOs before you can view the session.

Kelly actually participated in another excellent presentation titled “Good Trouble: ONC and CMS Introduced Interoperability Rules. Here’s What it Means for Your Practice.” It featured Care Journey’s President, Aneesh Chopra, and Aledade CEO Farzad Mostashari. It was arguably the most well-attended presentation this week. The focus was primarily about how interoperability is going to play a key role in value-based care going forward. It’s similar to what Maria spoke about with Travis Broome and Kent Locklear during the last NAACOS conference. Aneesh noted that the key word in everything that the ONC has put together is Substitutable Medical Applica Tions (SMART) on Fast Healthcare Interoperability R esources (FHIR). What SMART on FHIR does is, if you ask for it, give you that interoperability between EHRs and other applications. The problem is you have to actively ask for it i.e. it’s not “default” so to speak. It’s a step in the right direction, but I think everyone is a little frustrated with the fact that interoperability isn’t yet the default option.

I would be remiss not to mention that FLAACOS nearly didn’t happen. With the pandemic wreaking havoc on in-person events, some conferences didn’t have the experience to revamp their event into something virtual. FLAACOS managed to regroup and get everything together with the combined help of ACOExhibitHall and the Accountable Care Learning Collaborative. They did a solid job given the challenges. All the major topics were covered: direct contracting, behavioral health, interoperability, data analytics, policy changes, and COVID-19 challenges. At the end, the theme is that value-based care continues to evolve, and despite what 2020 has thrown at us, we expect to come back even stronger in the coming years. Hopefully we’ll see everyone in person in Orlando in 2021.

APG COLLOQUIUM 2020

Last, but certainly not least, the APG Colloquium. Another conference that’s typically in-person, but was virtual for the first time. I was really excited to go to the in-person APG Annual Conference, which is different from the colloquium, in San Diego. It’s nice to get to travel to places you don’t visit often. Unfortunately, the annual conference was canceled in the spring, and the 2020 Colloquium took place in the same place that every conference took place this year. If you guessed “in my house,” you are correct.

America’s Physician Groups has had this conference running since 2014, and they’re the leading national association of physician groups. When it comes to value-based care, these guys are more “boots on the ground” than even some ACOs. The colloquium is usually more policy based, and as expected Direct Contracting was a big topic of conversation. Also, the question of “Where is healthcare headed” seemed to pop up a lot. In fact, the keynote speaker was Congresswoman Donna Shalala, and her seminar was titled “ The State of Healthcare in America.”

This was something I really wanted to see for multiple reasons. First, Donna was actually my colleague, Amy Kotch’s professor in college when she was at the University of Miami. Second, my father actually hosted Donna at our house in Parkland, FL when she was campaigning for then-Governor Bill Clinton. My father’s radiology group, North Broward Radiologists, PA, had donated to Clinton’s campaign, so she came to speak to everyone. I said hello to her, but I was 13 years old, so I highly doubt she remembers me. Finally, and most importantly, she’s been involved in healthcare, specifically health policy, that I was probably most intrigued by her seminar more than anyone else.

Congresswoman Shalala discussed how we really need an integrated health system for the entire country, and that the COVID-19 pandemic has highlighted how fragmented our health system really is. Shalala pontificated that part of it is a mentality in how you bring about patient care. Because of this, she’s proud that the University of Miami, where she was President from 2001–2015, now requires their medical students to also get an MPH, alongside their MD, so that public health is top of mind when they get out into the field.

Congresswoman Shalala also mentioned how, mostly thanks to financial incentives, our healthcare system has been slimmed down to run more efficiently and to focus on outcomes. However, that meant that the health system had no built-in redundancies to handle something like a once-in-a-generation pandemic. She believes that agility matters, and we need to start incentivizing healthcare organizations and providers to provide care in a way that really matters given today’s challenges.

Another panel I enjoyed was Andy Slavitt, Marc McClellan, and Frederick Isasi’s “Mid-Pandemic: Should We Be Doubling Down on Value?” The general consensus was that it seems everyone is trying to, “get back to normal,” which means a lot of healthcare organizations are jumping right back into fee-for-service without really leaning into value-based care. All of the panelists agreed that alternative payment models work, but it’s just too easy for most organizations, which are businesses first, to go back to what doesn’t work for the country. At the same time there’s also a huge divide in how people relate to each other, and we can’t have a healthcare system that reflects that polarization. Value-based care works, but we need to get our focus in the right direction before we start actually changing anything. It may take some time. APG’s President and CEO, Don Crane, moderated most of the presentations, and as expected, had a lot of great questions for all of the speakers.

APG really has a different group of attendees, but some of the speakers are familiar if you’re used to attending a lot of population health conferences. Part of that is the world of population health isn’t very big. That being said, I enjoyed all of the conversations, and it really seems like everyone wants to head in the right direction. Let’s hope in 2021 we can actually start to do that.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Originally published at https://www.linkedin.com.

(Originally published on November 30, 2020 at www.salienthealthcare.com.)

I know they say do not bring politics to work, and 99% of the time I absolutely do not. However, when you work in healthcare, politics has a large effect on your working environment. I attend several conferences a year where Seema Verma is one of the keynote speakers. Her boss is the President of the United States, so after an election like this, I can’t really get away from politics. The question is, now that Joe Biden has been tentatively named President-Elect (we cannot refer to him officially until all electoral votes have been cast on December 14th), what does that mean for our industry and healthcare in our country? The real answer is not as much as you might think.

Membership in ACOs has received bipartisan support since it was first designed in 2006 by Elliott Fisher. Given that most of what we do, now, in value-based care has grown as a result of the Obama administration bringing about the Patient Protection and Affordable Care Act (a.k.a. “Obamacare”), so it’s safe to say that value-based care won’t be scaled back in the next four years. I fully expect President-Elect Biden to go all-in with value-based care, and actually attempt to rectify some of the loose ends that were left over at the end of the Obama administration. I realize that there’s supposed to be a ruling on the constitutionality of the ACA in 2021, and with the appointment of Justice Amy Comey Barrett slanting the Supreme Court even further right, I still don’t see anything changing (even if Congress is still a Republican majority).

Based on his support of the ACA from his previous term, I expect President-Elect Joe Biden to attempt to expand the ACA. However, he will certainly run into the wall that is Congress rendering him virtually ineffective ( I feel like that’s happened before). Therefore, any major reforms are likely to stall simply because of resistance within the rest of the government. However, you may see even more additions to the already expansive list of Alternative Payment Methods. That being said, I think everyone wants to wait and see how Direct Contracting works out first.

The reality is, it is not the election that’s going to have the biggest impact on our healthcare system. It’s the continued struggle with the COVID-19 pandemic. President-Elect Biden’s number one priority as soon as he steps foot into the Oval Office is to get control of Coronavirus, get people to wear masks, get a vaccine ready for public dispersal, and get America back to normal. What you’re going to see afterwards is probably a re-engaging with the World Health Organization and a complete top-to-bottom plan drawn out by healthcare professionals for how to handle a future pandemic (because there will be another one eventually).

Telehealth and Remote Patient Monitoring (RPM) has been top-of-mind for the last few months, and you’re going to see that continue to expand. Both of those technologies will continue to expand the reach of value-based care, and you’ll also see interoperability really start to push forward. Thus, you could say it’s less policy and more market need that will drive any healthcare industry changes we see between 2021 and 2024. Transparency and drug prices may be another area that you’ll see President-Elect Biden attempt to put his stamp on healthcare during his administration. However, it should be noted that because his main focus is the pandemic, and a COVID vaccine is going to come from “Big Pharma,” drug prices will be a sensitive topic.

If you’re all for more access, more transparency, and a more communal approach to healthcare, then the truth is it doesn’t matter who won the election because the Trump administration hasn’t been bad for healthcare, either. In fact, the GOP has strongly believed in healthcare reform, and pricing is still a bipartisan issue. At the end of the day, though, while I consider myself an optimist, I know nothing happens quickly in government. I also know the bureaucratic challenges President-Elect Biden will face, similar to what his President faced from 2008–2016. Healthcare is always a political football of sorts, and there’s often more noise than results. To this point, value-based care has already proven successful, so nobody should expect it to start to fade away. If you’re a betting person, it’s time to double down because even if it’s slow going, it’s still an exciting time to be in healthcare.

RESOURCES

• Contreras, B. (2020, September 16). The Transformation of Value-Based Care, its Future After COVID and the Election. Retrieved November 18, 2020, from https://www.managedhealthcareexecutive.com/view/the-transformation-of-value-based-care-its-future-after-covid-and-the-election
• MedTech Intelligence StaffInnovative Publishing. (2020, November 09). Election Day Topics: COVID-19 Surveillance, Value-Based Care, and Supply Chain Transparency. Retrieved November 18, 2020, from https://www.medtechintelligence.com/news_article/election-day-topics-covid-19-surveillance-value-based-care-and-supply-chain-transparency/
• PricewaterhouseCoopers. (2020, September). President-elect Joe Biden’s healthcare agenda: Building on the ACA, value-based care, and bringing down drug prices. Retrieved November 18, 2020, from https://www.pwc.com/us/en/industries/health-industries/library/election-2020-biden-health-agenda.html
• Reed, T. (2020, November 03). The 3 likely issues that will top Congress’ to-do list next year regardless of who wins the election. Retrieved November 18, 2020, from https://www.fiercehealthcare.com/practices/3-likely-issues-will-top-congress-to-do-list-next-year-regardless-who-wins-election
• Sauer, K. (2019, June 10). Readers React: Let’s not forget how Republicans blocked Obama’s agenda. Retrieved November 18, 2020, from https://www.mcall.com/opinion/readers-react/mc-opi-let-sauer-obama-republican-senate-block-legislation-20190610-pofcwevsg5awpitwvcsjsgx6ya-story.html

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Originally published at https://www.linkedin.com.

(Originally published on November 11, 2020 at www.salienthealthcare.com.)

One of the tenants of the Triple Aim — improving the experience of patient care (including quality and satisfaction) — looks to expand overall access to care. Over the last decade, technology companies began to focus on developing devices that would increase the access of America’s seniors to healthcare at home. Many forward-thinking industry professionals envisioned what the future of healthcare might be with new technology, not just for seniors, but everyone. In 2011, Microsoft created a promotional video depicting their idea of the future of healthcare, and many other tech companies, with the help of their marketing departments, produced something similar. Each of these common promotional videos depicted some sort of scenario where a person would go about their day, eat, exercise, and run errands all while any concerning changes in their health would be immediately transmitted to their doctor via a wearable device. Today, we are not particularly close to what that Microsoft promo video shows, and we’ve learned that a good idea, in theory, isn’t always so great in practice because success requires widespread adoption by the target market. Senior citizens consume a considerable amount of healthcare considering their population is 52 million, or about 16% of the American population. Some are quite tech savvy, but many are not. The result is that harnessing the power of healthcare technology to help those that need it most has been more difficult than expected.

It’s also important to note that technology companies were previously skeptical of their ROI and were hesitant to put out new technologies without proof that their costs, and efforts, would be rewarded with sales. Yes, better care, better access to care, and lower costs are always the goal, but a low ROI is a huge deterrent. Prior to 2020, it wasn’t uncommon for Medicare beneficiaries to be less likely to use some of the new technologies; Medicare beneficiaries skew less tech savvy and prior policies burdened them with significant out-of-pocket costs. That added risks which also acted as barriers to progress on the side of tech companies. If Medicare beneficiaries weren’t using the available technology, then Remote Patient Management (RPM) was essentially impossible. Thankfully today’s Medicare beneficiaries (specifically baby boomers), primarily through exposure, are beginning to graduate to a more tech savvy position. It’s important to note that previously patients did have to pay their own way for equipment, and there wasn’t much provider reimbursement to add incentive. There’s also the bureaucratic burden involved in putting out a new healthcare product. Technology moves fast…government does not (have you ever been to the DMV?). New products first have to be approved by the government, and then they have to be approved by Medicare so that providers can get reimbursed for distribution. Remote Patient Monitoring (RPM) is a great example of this. Providers want to use RPM, but there are a lot of barriers to entry. Most patients have to pay their own way for the equipment today, and providers don’t receive much fee-for-service revenue to do it. Thus, the incentive is minimal and the effort is significant. That’s not a winning combination. Therefore, some roadblocks are going to be tough to remove, but finally we see some are already starting to be broken down.

Just before NAACOS Fall 2020 the Centers for Medicare & Medicaid Services issued a proposed rule that is designed to allow Medicare beneficiaries to use brand new technologies as they arrive on the market. The rule is titled Medicare Coverage of Innovative Technology (MCIT) (CMS-3372-P), and according to CMS Administrator Seema Verma, “For new technologies, CMS coverage approval has been a chicken and egg issue. Innovators had to prove their technologies were appropriate for seniors, but that was almost impossible since the technology was not yet covered by Medicare and thus not widely used enough to demonstrate their suitability for Medicare beneficiaries.” However, now according to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, “This new proposal would give Medicare beneficiaries faster access to the latest lifesaving technologies and provide more support for breakthrough innovations by finally delivering Medicare reimbursement at the same time as FDA approval.”

WHAT DOES THAT MEAN?

The short answer is that instead of the lag that occurs from development to market-ready due to the approvals process by both the FDA and Medicare, which eats up money, resources, and delays adoption, now there’s technically a fast track to bypass these bottlenecks. Medicare Coverage of Innovative Technology (MCIT) now allows for the FDA to label a particular product to be considered a “breakthrough” as long as it involves new technology that diagnoses or treats life-threatening or debilitating diseases or conditions. CMS then has four years to re-evaluate this particular product based on real-world evidence. Seniors who were previously prevented from using new technologies while they wait in “limbo,” or to use a movie production term, “development hell,” now can be fast-tracked into using these new devices because they would both be approved and covered by Medicare right away. Covered is the real key because that means technology such as RPM is much easier to implement since incentives are properly aligned, reimbursement would be immediate, and beneficiary out-of-pocket expenses are likely to decrease.

This rule is merely proposed, and at the moment, it could still change. Also, commercial payers aren’t yet allowed to be involved, however, the proposed definition does allow CMS to review coverage policies and analyze them for coverage parameters that would be applicable to the Medicare population. Thus, those with commercial insurance may benefit from this rule later on. The submission of public comments has just passed, so we should know more early next year. That being said, it’s exciting to think what may lie ahead. We may not be where the above Microsoft video predicted we might be, but at least we’re finally free to actually head in that direction.

RESOURCES

• Berwick, Don M., and J. Whittington. “The Triple Aim: Care, Health, and Cost: IHI.” Institute for Healthcare Improvement, The Triple Aim: Care, Health, and Cost. Health Affairs, 27 June 2008, www.ihi.org/resources/Pages/Publications/TripleAimCareHealthandCost.aspx.
• CMS. “Fact Sheet Proposed Medicare Coverage of Innovative Technology (CMS-3372-P).” Proposed Medicare Coverage of Innovative Technology (CMS-3372-P), Centers for Medicare & Medicaid Services, 31 Aug. 2020, www.cms.gov/newsroom/fact-sheets/proposed-medicare-coverage-innovative-technology-cms-3372-p.
• Mather, Mark, et al. “Fact Sheet: Aging in the United States.” Population Reference Bureau, 15 July 2019, www.prb.org/aging-unitedstates-fact-sheet/.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Originally published at https://www.linkedin.com.

(Originally written on August 13, 2018 and published as a two-part blog on August 15, 2018 and August 21, 2018 at www.salienthealthcare.com.)

As it currently stands, the Centers for Medicare & Medicaid Services (CMS) allow Accountable Care Organizations (ACOs) to dip their proverbial toe in the waters of Value Based Payment by entering the world of the Medicare Shared Savings Program (MSSP) in Track 1. Those in Track 1 receive what amounts to a three-year trial (with an option to extend the trial another three years) in a one-sided risk model whereby they will receive some shared savings, should they achieve it, but they’re exempt from any shared losses. When ACOs started signing contracts in 2012, it was expected that those starting in Track 1 would ultimately matriculate through the program such that after three years they would evolve into Track 2, taking on moderate downside risk that could not exceed 15%, but they would also be rewarded with greater shared savings should they succeed. CMS had been optimistic that once ACOs learned how to properly manage risk, they would choose to evolve into Track 3, taking on downside risk that would not exceed 20%, and then they would eventually take on the responsibility of a Next Generation ACO. Once contracted as a NextGen ACO, the organization stands to make the most money in savings, but also carries the weight of full downside risk.

Fast forward to 2018; CMS is finding out that many ACOs are either unprepared to take on downside risk, or they are completely averse to it altogether. Compounding the issue is that the MSSP has actually shown some increases in net spending for a portion of ACOs that are not physician-led (which some speculate this may be due to layers of bureaucracy muddying the waters). This comes as a surprise because the thought process, all along, was to get ACOs to lead the charge of narrow provider networks that would quarterback patient healthcare, creating an environment that emphasized a relationship-focused, team-based approach to health and wellness instead of the traditional transactional approach. This, in turn, would lower overall costs. It is more than likely that CMS underestimated the learning curve on both the physician-led and administrator-led (hospital and non-hospital) ACOs with regards to converting from Fee For Service to Value Based Payment.

There are currently 561 ACOs in the United States, and the law of averages suggests that not everyone would jump into the game for the right reasons, and a small percentage of ACOs would just be weeded out. On August 9, 2018, via their “Pathways to Success” proposal, CMS made the world aware that they plan to shorten the time Track 1 ACOs have available to take on risk, as 82% (460 out of 561) are balking at moving past Track 1. Instead of three years, ACOs would only have two in what has been dubbed the BASIC track, and there would be no option for an extension. The question is if, and when, CMS will officially implement this plan.

CMS is accepting comments on their proposal from ACOs and ACO stakeholders through October of this year. As an aside, I do believe CMS has overlooked one piece of human nature that is at play here. For illustrative purposes I am going to use baseball because I have often found the game eerily correlates to life in its ups, downs, and use of strategy. Let’s say you are a coach/general manager, and you must select a few players to put on the field. You have a choice of three batters. Batter A is a light hitting player with a high batting average who has a few years of experience under his belt. Batter B has more home run power, but he also is prone to striking out. Batter C hits even more home runs, and he also strikes out at a higher rate. To top this off, he is also very young, so he needs a lot of coaching. High risk, high reward.

The player you would select for your team is entirely based on your experience as a coach. If you have never previously coached a team, you want as many “Batter A’s” as you can get. He might never hit a home run, but he will do well enough to keep your team competitive. Over time, you will be more willing to sprinkle in a few “Batter B” types. Only those who have really mastered the game are comfortable with a stable of “Batter C” players because they know how to handle risk, and they know how to keep the high risk, high reward players focused.

Bringing this back to healthcare, there are three problems today’s ACOs are faced with.

1. It takes time to master running the ACO.
2. Not everyone is truly comfortable with risk, yet (and some may never be).
3. Medicare feels as though it is running out of patience supporting those who delay taking on risk.

In CMS’s perspective, it’s sink or swim time. The ACOs appear to want more time to figure out the ever-evolving world of VBP. Who is in the right? What is the right amount of experience required to truly learn the ins and outs of MSSP?

The truth is that if today’s healthcare professionals are going to change the way that healthcare is practiced, they need to move forward quickly. They also need to be okay with navigating treacherous waters without a very detailed map. To succeed, leaders need to invest strategic software that promotes population health analytics, as well as talented data analysts. They also need to keep close tabs on the ever-evolving rules and regulations put forth by CMS. Sometimes it is better to play a little small ball instead of trying to compete with everyone else by hitting grand slams.

CMS’s belief that the ACO model can work is correct. It is just a matter of getting those involved to push forward a little harder and become a more aggressive. Not that there is much of a choice anymore because if CMS is the umpire, they just yelled, “PLAY BALL!”

RESOURCES

• Berkland, J. M. (2018, August 10). CMS proposes Medicare ACO overhaul to prod more risk-taking. Retrieved August 13, 2018, from https://www.mcknights.com/news/cms-proposes-medicare-aco-overhaul-to-prod-more-risk-taking/article/787527/
• Centers for Medicare & Medicaid Services. (2018, June 11). Retrieved August 13, 2018, from https://www.cms.gov/
• Freeman, G. A. (2018, May 7). Track 1 ACOs Likely to Bail Out Rather Than Assume Risk. Retrieved August 13, 2018, from https://www.healthleadersmedia.com/finance/track-1-acos-likely-bail-out-rather-assume-risk
• Leventhal, R., & Landi, H. (2018, August 9). BREAKING: CMS Proposes Sweeping Changes to MSSP ACO Program. Retrieved August 13, 2018, from https://www.healthcare-informatics.com/article/value-based-care/breaking-cms-proposes-sweeping-changes-mssp-aco-program
• Morse, S. (2018, August 9). CMS overhauls Medicare ACO program by limiting upside risk to only two years. Retrieved August 13, 2018, from https://www.healthcarefinancenews.com/news/cms-overhauls-medicare-aco-program-limiting-upside-risk-only-two-years
• Muhlstein, D. B., Morrison, S. Q., Saunders, R. S., Bleser, W. K., McClellan, M. B., & Winfield, L. D. (2018, February 12). Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings. Retrieved August 13, 2018, from https://www.ajmc.com/journals/ajac/2018/2018-vol6-n1/medicare-accountable-care-spending-patterns-shifting-expenditures-associated-with-savings
• Porter, S. (2018, August 9). Proposed ACO Models Would Hasten Downside Risk. Retrieved August 13, 2018, from https://www.healthleadersmedia.com/finance/proposed-aco-models-would-hasten-downside-risk
• Robeznieks, A. (2018, March 1). Physician-only ACOs lead the way on improving quality and savings. Retrieved August 13, 2018, from https://wire.ama-assn.org/practice-management/physician-only-acos-lead-way-improving-quality-and-savings
• Shyrock, T. (2017, February 25). Is the success of physician-led ACOs sustainable?. Retrieved August 13, 2018 from http://www.medicaleconomics.com/medical-economics-blog/success-physician-led-acos-sustainable/page/0/1
• Verma, S. (2018, August 9). Pathways to Success: A New Start for Medicare’s Accountable Care Organizations. Retrieved August 13, 2018, from https://www.healthaffairs.org/do/10.1377/hblog20180809.12285/full/

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

(Originally published on December 4, 2018 at www.salienthealthcare.com.)

Mother knows best, as the phrase goes, and just like my mother, photographed with me here in the summer of 1981, she always knew how I was feeling and what I needed before anyone else. Running a fever? Mom knew before she even put the thermometer in my mouth. In fact, I specifically remember my mother telling my father, “Dennis, I think he’s getting sick,” before I ever felt any symptoms. I always wondered how she knew such things. Moms know their children so well that even the slightest change in skin color, temperature, breathing, or personality sets off a red flag that tells them, “We need to go to the doctor!”

Fast forward to adulthood and the responsibility of making sure you are healthy falls squarely on your own shoulders. There’s nobody there to make sure you take your medicine, see your doctor every year, and get enough rest. Without an inherent motivation, how healthy are you? If we look at CMS numbers, as a country, maybe we aren’t doing as well as we would hope, with two-thirds of beneficiaries having multiple chronic conditions. This is why the Center of Medicare and Medicaid created the Accountable Care Organization. The responsibility of your wellness is tied to provider reimbursements and bonuses. The missing “mom piece” is added back into your healthcare. Your primary care physician becomes your greatest asset in ensuring proper health and maintenance.

So how are providers held accountable? The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a patient survey, which identifies just how communicative and involved the provider is with their attributed population. For quality healthcare to be effective, there has to be a solid relationship at the foundation. Someone has to care the way your mom did!

Another way providers are held accountable is through the Group Physician Reporting Option (GPRO), which consists of a number of quality metrics governing topics of preventative medicine, chronic care management, and population health. In order for ACOs to see their first penny, if they’ve saved enough money, they must be in full compliance with GPRO.

Dr. Brian Holzer, CEO at Lacuna Health, spoke at this autumn’s FLAACOS 2018 Conference (pictured above) about how our health system has focused on episode-based financial incentives as opposed to truly focusing on patient needs, and I believe he is right. Since the beginning of the Medicare Shared Savings Program in 2012, every thought, Final Rule, and amendment to the MSSP program has been with “Patient Care” and “Population Health” as the battle cry. However, fee-for-service and distribution of dollars have been the backbone.

Maybe it’s time to really sit down and think about how patients are cared for instead of how much we can make off of care. A well-respected physician who practices in an ACO once said to me, “If I have the right incentive structure behind me, I know comfortably, that if I give the right care to my patients when they need it, the money will follow.” Those are the words our doctors across the nation need to speak. It’s time for our legislation to provide those incentives.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

(Originally published on October 15, 2019 at www.salienthealthcare.com.)

A Collaborative Article by Amy Kotch and Ryan Mackman

The recently publicly traded companies of Lyft and Uber have been in the news almost every day, but we picked up on a part of their business plan that may have flown under the radar for most: Both companies are teaming up with Medicare Advantage plans to provide Medicare beneficiaries with safe and reliable non-emergency medical transportation (NEMT) to-and-from their healthcare provider [1,2]. With the incorporation of new rules which allow for proper reimbursement in various states, patients will finally be able to solve for a major issue that has been adversely affecting the healthcare world for years: access to care.

Access can single-handedly break the healthcare system because patients can’t get healthcare if they don’t have a way to get to their doctor, and patients can’t receive prescriptions if they don’t have transportation to the pharmacy. Also, from a Social Determinants of Health perspective, senior patients can’t resume normal life activities if they don’t have the capability to get to religious services, Mahjong club, or even their local community center. Lyft and Uber’s plan to solve for the access issue will largely open up opportunities that have been plaguing the healthcare industry, and our Medicare beneficiaries, for years.

Since 2010 the Medicare population has been growing at a steep rate of about 5.1% [3], and according to the Kaiser Family Foundation, Medicare Advantage is predicted to grow 47% by 2029 [4]. With this fast-growing elderly population, it’s important to ensure that patients are able to see their providers on a regular basis so to manage chronic conditions, render preventative services, and address acute healthcare problems that can unexpectedly arise.

This presents the perfect time for ride sharing organizations to get into the healthcare industry. Transportation, as a benefit, alone has a chance to expedite Medicare Advantage’s ascendance as the health plan-of-choice for America’s senior population. It would also save CMS a considerable amount of money, and when you consider that 3.6 million individuals do not have access to medical care because they experience transportation barriers (it’s the third leading cause of missing a medical appointment for seniors) [5] you start to see how all the puzzle pieces could fit together in the very near future. Hospitals and private practices are behind this initiative because it could cut down the number of no-shows that they routinely face, which present their own operational and financial challenges.

Among those who face transportation barriers, some of the issues they face include [5]:

1. Long travel distances
2. Lack of vehicle
3. Transportation cost
4. Inadequate infrastructure
5. Adverse policies affecting travel

What’s important to note here is that three of the five challenges listed above are going to be solved with ride sharing by Medicare Advantage. Long travel distances can’t necessarily be solved, but that challenge can be mitigated if a patient is willing to sit in a Lyft or Uber for a 45 minute ride if need be. At a minimum, it simplifies the process for those who may have had to rely on public transportation, requiring multiple stops or transfers, to get to their doctor. Disabilities can be an issue, too, as vehicles with modifications to support wheelchair-bound patients are expensive. Thankfully, Uber also offers wheelchair accessible transportation which means those beneficiaries with disabilities will also have access to transportation.

Finally, there are other cost-savings to consider. A study at the University of Kansas found that there was at least a 7% decrease in the rate of ambulance use based on data from the National Emergency Medical Services Information System and Uber [6]. This implies there is ambulance use when there’s no real need, tying back to a previous Salient Healthcare blog about ER Overutilization. Increased transportation and access opens the door for several other beneficiary benefits such as home care and delivery of durable medical equipment.

For a healthcare system that needs considerable modification, the availability of ride sharing options to Medicare Advantage beneficiaries stands to be one of the most impactful, and welcome, changes to population health. It gives many people a chance at a healthier life, a chance to participate in the community, and provides many beneficiaries something they may not have experienced in a long time…hope.

RESOURCES

1. https://homehealthcarenews.com/2019/05/lyft-to-partner-with-majority-of-largest-medicare-advantage-plans-by-2020/
2. https://www.forbes.com/sites/brucejapsen/2019/05/30/lyft-hails-medicare-advantage-as-its-next-profitable-ride/#2126126341d1
3. https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/
4. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2019/
5. https://www.aha.org/system/files/hpoe/Reports-HPOE/2017/sdoh-transportation-role-of-hospitals.pdf
6. https://medium.com/swlh/how-uber-and-lyft-became-major-players-in-the-healthcare-space-38a06285e890

BIOS

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

Amy Kotch is Salient’s Principal Business Consultant working with ACOs nationwide. She received a masters in health administration from Florida Atlantic University as well as a bachelors of science from the University of Miami and has just recently completed a master certification in population health through a federal grant from the Office of the National Coordinator for Health Information Technology in conjunction with the Johns Hopkins University and Normandale Community College. Her prior work includes being the operations coordinator at Triple Aim Development Group consulting with ACOs/MSOs.

(Originally published in two parts on June 13 and July 2, 2019 at www.salienthealthcare.com.)

Ever heard the saying, “You are what you eat?” Nutrition plays a big role in population health. Poor nutrition can lead to chronic health issues, such as obesity, diabetes, and heart disease. When large numbers of patients have these chronic health issues, the costs of their combined healthcare can skyrocket. When there are large numbers of beneficiaries attributed to an Accountable Care Organization with uncontrolled health issues caused by poor diet, the result is often beneficiaries with very poor health, high risk scores, poor quality measures, and a significantly reduced opportunity for achieving shared savings.

Diet is so important that it is also listed as one of the cornerstones of Social Determinants of Health ( see graphic below), which is about understanding the relationships between the environment that a population lives in (the locations where they’re born, live, work, worship, grow old, etc.), the social and economic conditions of those environments, and how that impacts the overall health of that population. In the recent past, we have treated health issues based on the symptoms they display. However, as we’re increasingly learning, the health of a particular population is often determined by the interconnected circumstances that govern their lives. A few examples of SDOH by the New England Journal of Medicine include: Income Level, Educational Opportunities, Occupation and Workplace Safety, Gender Inequity, Racial Segregation, Food Insecurity, Early Childhood Experiences, Social Support and Community Inclusivity, Crime Rates and Exposure to Violent Behavior, and Availability of Transportation.

In essence, it’s part of a nature vs. nurture conversation focused specifically on healthcare. If a set of twins were separated, and one was brought up in a nice gated community in Boca Raton while the other grew up in more rural Belle Glade, would they have similar health outcomes? Boca Raton is a wealthy city in Palm Beach County where the U.S. Census Bureau states that the median household income was above $76,000 in 2017. With Florida Atlantic University and Boca Raton Regional Hospital right in the center, the city of Boca Raton is a great place to nurture community growth. Belle Glade is also in Palm Beach County. In the same time frame, the U.S. Census Bureau states that the median household income was $25,873. 40% of the city is considered poor. Only 62% of Belle Glade has a high school degree compared to 96% of Boca Raton. Finally, while 95% of Boca Raton has a computer, only half of Belle Glade does. The picture is clear that if that set of twins was separated, the person who grew up in Boca Raton would have advantages that the person in Belle Glade likely would not. If someone ran an ACO with beneficiaries attributed to medical practices in Belle Glade, they would have to take a closer look at Social Determinants of Health if they wanted to improve under the rules of the MSSP program.

Social Determinants of Health is playing a much larger role for Accountable Care Organizations than previously anticipated. As ACOs continue to strive to lower the cost of healthcare in the United States, they often emphasize that providers must increase their Annual Wellness Visits due to the beneficial cascade effect it brings to the five major Key Performance Indicators (Finance, Risk, Quality, Attribution and Utilization). Sometimes just getting someone into the office for their Annual Wellness Visit can be a challenging undertaking, but what if they don’t have a way to get to the doctor’s office at all? What if they’re eating fast food every day because it’s the only thing they can afford, or they’re only eating once per day? How about once every three days? It’s possible that even if they could have a friend drive them to the doctor, they may not be able to afford the office visit. What do those people do? They head to the Emergency Room every time they don’t feel well. Through Salient Healthcare Dashboards and Salient Interactive Miner, it isn’t uncommon to see these types of patients utilize the ER over 100 times in a year. Let that sink in, and then think about the cost. Now imagine the cost if those patients also have chronic conditions, like diabetes, because more often than not, they do.

Now you know how diet can have a major impact on population health because of how it integrates with SDOH whereby poor health can be traced back to a compounding of issues including economic hardship, poor access to healthcare, lack of health education, mental health issues, or even cultural beliefs. The next question is, “How does that impact Accountable Care Organizations?”

ACOs were created out of necessity to care for patients with complex, chronic conditions who frequently burden the healthcare system with high expenditures and utilization. The American Diabetes Association says that 9.4% of Americans, or over 30 million people, are currently living with diabetes (much of which is nutrition-related). Other statistics show that diabetes causes more deaths per year than breast cancer and AIDS combined, and having diabetes nearly doubles your chance of having a heart attack.

CMS states that in 2017 about 2.3% of Medicare beneficiaries had type 1 diabetes while 18.9% had type 2. Another 6.6% are prediabetic, meaning that nearly 28% of the beneficiaries in the MSSP program are dealing with some form of diabetes. Over 70% of those patients are dealing with other chronic conditions such as hypertension, obesity, or nonalcoholic fatty liver disease. This ties directly back to the nutrition issue. If a beneficiary has poor nutrition and they have trouble making it to see their primary care physician (SDOH), then you start to see the compound effect of Social Determinants of Health and Diabetes can have for ACOs.

The major takeaway from all of this is that the food we put in our bodies has a massive impact on our overall health. If you want to lower the cost of healthcare in the United States, it’s worth first considering what is on the dinner table, and why that’s on the dinner table for much of the country’s population before providers start prescribing expensive drugs and procedures.

Zoraime Ramos Cortes is a Public Health Nutritionist Supervisor for the Florida Department of Health. Having previously been on staff as a dietitian at Wellington Regional Medical Center, she sees, first-hand, the interaction between SDOH, diet, and inpatient admissions. “For many health conditions, diet is at the root cause of disease states. What we put into our mouths throughout each day, will have a major impact on our health outcome for years to come. Unfortunately, social determinants of health also play a major factor in our health, at times, dictating what foods or resources will be available to certain populations for consumption,” says Ramos Cortes.

“For example, as a population, practitioners are beginning to see disease states, such as hyperlipidemia, hypertension, Type 2 Diabetes, and obesity become leading causes of death, and even emerge in children as young as 5 years of age; chronic illnesses which were typically seen in middle aged adults.”

“Education is definitely the key when it comes to prevention and management. The better understanding a person has of food labels and portion control, the more control, and the more confidence the patient will have in managing their health. Education will empower the patient, leading to patient centered care.” — Zoraime Ramos Cortes, MS, RDN, LDN

Ramos Cortes also mentioned that healthy, affordable foods are becoming less available to particular populations, many of which reside in food deserts. If your ACO is in a food desert, that will have a massive impact on overall quality measures.

ACOs don’t always have dietitians under their stead, but it’s practicing good population health if they begin discussing the possibility of bringing dietitians into their networks to get out in front of health issues before they become too problematic. By promoting diet education among their patients, those whom don’t have diabetes are less likely to acquire it later in life. Those whom do live with diabetes can better manage their disease before cataracts, glaucoma, kidney disease, and diabetic heart disease set in, significantly increasing the cost of care as the patient’s health deteriorates.

If ACOs can get their patients to see their PCPs for Annual Wellness Visits, have them regularly check their HbA1c, get them in for diabetic retinal screening, and educate them on proper nutrition, it won’t fix everything. However, it will go a long way towards practicing good population health and easing some of the stressors on the American healthcare system. It’s a long road to get where we want healthcare to be, but at least we now know there’s a path available to us.

BIO

Ryan Mackman has been an ACO business consultant team member with Salient since 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Masters in Business Administration and a Masters in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.