Papers by Michael Millenson
UNSTRUCTURED For those of us who believe deeply in a collaborative relationship between patients ... more UNSTRUCTURED For those of us who believe deeply in a collaborative relationship between patients and doctors, the chaos created by the COVID-19 pandemic has brought an uncomfortable question to the fore: Is participatory medicine still relevant during a pandemic? Drawing liberally upon the Jewish tradition of Talmudic reasoning, I would like to offer 3 considered replies: “Yes,” “no,” and “it depends.” Sometimes, patients may have no choice but to cede control to medical professionals, even though patients are still the experts on their own lives. Other times, the shared control of participatory medicine is both an ethical and clinical imperative. However, as the worldwide toll exacted by COVID-19 has made us grimly aware, no one is really in control. That is why, in these uncertain times, the path forward requires maintaining mutual trust between health care providers and patients, whatever the circumstances. After all, it is our bodies and our selves at stake.
Health affairs (Project Hope), Jun 1, 2017
Leape’s Making Healthcare Safe
American Journal of Medical Quality, 2022
Healthcare, 2018
Although there is a widespread belief that ACOs must be patient-centered to be successful, eviden... more Although there is a widespread belief that ACOs must be patient-centered to be successful, evidence to guide them in achieving that goal has been lacking. This case report examines four ACO innovators in patient-centered care that together represent urban, suburban and rural populations with a broad range of economic, racial, ethnic and geographic diversity. Seven patient-centeredness strategies emerged: transform primary care practices into patient-centered medical homes; move upstream to address social and economic issues; use both high-tech and high-touch to identify and engage high-risk patients; practice a whole-person orientation; optimize patient-reported measures; treat patients like valued customers; and incorporate patient voices into governance and operations. Exemplars prioritized direct care interventions perceived as central to financial and clinical success, and organizational maturity played a role. Activities that decreased the traditional system's authority, such as incorporating patient voices, were less popular. Local practice factors were important, and a mixture of mission and margin energized front-line staff in implementing patient-centered care as "the right thing to do." Unresolved questions remain that are related to the impact of individual and multiple interventions and how successful interventions can be disseminated widely. In order for patient-centeredness innovations to enable transformation, providers, payers and policymakers alike must consciously adopt strategies that nurture it.
Summary - Will the Affordable Care Act Move Patient-Centeredness to Center Stage?
Diagnosis, 2014
A best-selling book from the mid-1980s was entitled,
Note on Accountability in the U.S. Health Care System
The sea change of the see-through hospital--and how to stay afloat
Healthcare financial management : journal of the Healthcare Financial Management Association, 2008
In the new era of transparency, hospitals need to understand that payers, competitors, and consum... more In the new era of transparency, hospitals need to understand that payers, competitors, and consumers are looking closely at their clinical quality performance. That increased scrutiny promises financial consequences if hospitals fail to live up to their ideals.
Quality and Safety in Health Care, 2002
Evidence-based medicine: Why the time is now
Journal of Medical Marketing, 2001
Four of the five factors necessary for an innovation to take hold — compatibility with existing v... more Four of the five factors necessary for an innovation to take hold — compatibility with existing values and behaviours, lack of complexity, the ability to be subjected to experiment (trialability), and the ability to produce results everyone can see (observability) — are now present in regard to evidence-based medicine. The fifth factor — relative advantage — is only partly present, but it is becoming more prevalent.Barriers include the failure of patients and doctors to differentiate between scientific training and scientific practice, to be seduced by technology and to be influenced more by pop-culture portraits of medicine than by the medical literature. Moreover, it has not yet clearly been demonstrated that it is to the economic or political advantage of any interest group to push for evidence-based medicine. Part of the reason is that there have been no easily identifiable victims to galvanise political pressure from the general public. Nonetheless, the situation is changing for the better.
The Promise Of Personalized Medicine: A Conversation With Michael Svinte
Health Affairs, 2006
In early 2004, IBM combined its Healthcare unit, which focused on the technology needs of provide... more In early 2004, IBM combined its Healthcare unit, which focused on the technology needs of providers, with its Life Sciences unit, which catered to research scientists. Out of that union was born an "emerging business opportunity" called information-based medicine, in which IBM has already invested tens of millions in the expectation of reaping billions of dollars in revenues. Michael Svinte describes his mission as providing the information technology infrastructure that will enable technologies such as proteomics and molecular imaging to progress from the bench to the bedside, thereby resulting in predictive and personalized health care.
There are three, and only three, ways to reduce the total cost of any good or service: pay less p... more There are three, and only three, ways to reduce the total cost of any good or service: pay less per unit; use fewer units; or improve efficiency and effectiveness so that less money and/or fewer units are needed to achieve the desired result. With trembling hands, the U.S. health care system is preparing to give the third method a serious try. Government-controlled systems excel at the first two options. They set global budgets, prescribe prices and proscribe pricy new technologies until there's tangible proof of need. The decisions about each individual's care may ultimately lie with clinicians, but government or government-funded intermediaries can place a heavy thumb on the scale. In this country, Medicare and Medicaid offer less-comprehensive versions of price and utilization controls through a kind of single-payer "light." The effectiveness of these strategies, however, is now facing unprecedented challenge. Were the draconian 24.4 percent cut to physician pay mandated by the Medicare Sustainable Growth Rate (SGR) formula for 2014 to go into effect, the program would be thrown into chaos. On the demand side, meanwhile, as many as 32 million Americans could enter the health-care system because of the Patient Protection and Affordable Care Act (ACA), upping national use of medical services at the same time aging Baby Boomers are doing the same.
Quality and Safety in Health Care, 2004
Israel Journal of Health Policy Research, 2020
The scope of health information and health care services available online is rapidly expanding. A... more The scope of health information and health care services available online is rapidly expanding. At the same time, COVID-19 is causing vulnerable elders to reconsider in-person provider visits. In that context, recently published research by Y. Mizrachi et al. examining obstacles to the use of online health services (OHS) among adults age 50 and up takes on new importance. An iconic Israeli song begins, “Will you hear my voice?” (Hebrew Songs. Zemer Nugeh (Hatishmah Koli), 2020). What makes Mizrachi et al.’s findings particularly intriguing, despite several caveats, is the manner in which they demonstrated a commitment to genuinely listen to individual voices. The researchers spoke “openly and bluntly” with interviewees as peers and were rewarded with “specific, well-defined and applicable answers with the potential to be used.” The most striking findings came in candid answers that went beyond the factors intrinsic to the online offerings and addressed important factors in what regu...
Quality and Safety in Health Care, 2002
Effective public accountability in health care demands effective communication to the public. The... more Effective public accountability in health care demands effective communication to the public. The public release of healthcare performance information can easily turn into a media circus focusing on boondoggles and body counts. Michael Millenson, a former reporter with the Chicago Tribune who went on to become a health services researcher and author, reflects on the minor media storm that accompanied release of a study by the UK's National Patient Safety Agency (NPSA). Releasing public information on medical errors is a delicate task. Context—or, more cynically, what modern public relations practitioners would call “spin”—is critical. At one extreme there is the “bad is good” approach of The Doctor's Dream , in which the 19th century British physician William Snowden Battles gave this tongue-in-cheek confession of his shortcomings: And thus I dreamt that round me stood The victims of disease The patients I had failed to cure Though some had paid my fees. One said, “It is a h...
This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jef... more This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been
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Papers by Michael Millenson