Joshua Liao, MD

Lessons from the meeting of different value-based concepts

Policy

October 19, 2018

Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations (e.g., value-based care redesign), pharmaceutical companies and pharmacy benefits managers (e.g., value-based pricing and formularies), and private companies (e.g., value-based technology assessment).

This trend highlights a critical point: Discussions about value …

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Are hepatits C drugs too expensive? Analyzing the pros and cons.

Joshua Liao, MD

Conditions

April 5, 2018

The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive.

On the one hand, sofosbuvir produces cure rates of >90%, a figure that seemed unthinkable a few decades ago. On the other, it is priced at approximately $1000 per pill ($60,000–$90,000 for a treatment course), making it …

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Pay for performance: Have we gotten what we’ve paid for?

Joshua Liao, MD

Policy

January 27, 2018

In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) — a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on a set of quality and cost measures. The authors were interested in 2 questions: Is engagement in VM associated with changes in provider performance on quality or cost measures? Does …

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Professionalism charters for health care organizations are needed now

Joshua Liao, MD

Policy

December 22, 2017

In a recent article in Annals of Internal Medicine, physicians from the University of Missouri described their experience helping to create a “professionalism charter” for health care organizations. As the authors note, the need for such a charter is heightened by the troubling health climate, with millions of patients at risk of losing insurance coverage, scores of physicians experiencing burnout, and health care organizations grappling with how to preserve …

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Value to patients and value to society: How can doctors balance the tension?

Joshua Liao, MD

Policy

November 19, 2015

Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.

Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …

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Strong ethical principles should guide EHR implementation

Joshua Liao, MD

Tech

July 29, 2015

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The U.S. health care system is headed toward a profoundly digital future. Provider organizations around the country are adopting and updating their health information technology (HIT) infrastructures. Many have begun requiring that clinicians gain proficiency in electronic health records (EHRs) in order to provide clinical care. A proliferation of start-ups and HIT companies in health care is poised to disrupt (innovatively or …

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Digital natives: Implications on physician evaluation

Joshua Liao, MD

Education

March 26, 2015

I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently …

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Improve teamwork with better selection of medical trainees

Joshua Liao, MD

Education

February 18, 2015

Amid the many ongoing changes to health care, it’s clear that better teamwork is needed in American medicine. Calls for stronger interdisciplinary collaboration have permeated position statements and policies, and organizations have begun redesigning care processes to include novel team-based approaches. Emerging data continue to affirm that strong teamwork and communication can increase the value of care.

Of the many efforts to improve teamwork, however, one potential area for significant improvement …

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