Blog

Looking Within the Complex Healthcare Ecosystem to the Real

Thu, 19 Mar 2026 12:41:00 GMT

Dr. Ezekiel Emanuel’s article is a description of an inefficient healthcare ecosystem and a plea for better tools to counteract the forces causing inappropriately high health care costs. Dr. Emanuel implicates behaviors of providers and patients as causal mechanisms. Dr. Robert Califf goes even further claiming the ecosystem is imbalanced and this causes harm, primarily by implicating pharmaceutical pricing caused by charging what the market will bear. Dr. Emmanuel embraces the entire health care ecosystem operating to cause high health care costs due to mechanisms collectively deemed behaviors. Of the four main categories of cost, administrative, procedures, imaging, and pharmaceuticals, each is at risk of excessive use because of modifiable behaviors. Exploring the many causes of behaviors, the ecosystem offers an opportunity for asking questions that identifies these causes, regarding the ecosystem and the patient holistically. On the other hand, Dr. Califf has a reduc ...

Primary Care and Artificial Intelligence

Sun, 03 Aug 2025 08:03:00 GMT

This very interesting article by Gordon Shiff elegantly lays out a lament for primary care and for that matter the primacy of cognitive clinical medicine. It is a truism AI is a tsunami throughout the world’s economies and it is no surprise clinical medicine will be effected as well.

Causal Methods for HealthCare

Thu, 26 Dec 2024 17:39:00 GMT

As a planning tool, causal queries differ from simple predictions by framing the future as truly new and unique and not fully described by past events. Support for a future orientation includes more than quantitative data analytics of known data, but a qualitative suite of potentialities generated from domain experts. This blog will suggest how to develop a formal mathematical interaction that blends the past and the future.

Transformation Potential for Medicaid Policy Using Counterfactual Properties.

Tue, 31 Jan 2023 20:44:00 GMT

Health care transformation obliges stakeholders in the ecosystem to coordinate. Private and public health plans articulate policy, provider networks deliver care, and patient’s experience care. The glue that holds these stakeholders together is reimbursement. Transformation however requires more than manipulating policies of transactions. This project offers a new way to look at the entire ecosystem using a small set of TennCare data that illustrates how counterfactual methods can serve to extend the scope of information available for transformation.

Technology Medicaid Managed Care Conference 2022

Wed, 10 Aug 2022 14:10:00 GMT

The presentations of the 2022 Medicaid Managed Care Conference in New Orleans moderated by Virginia Burchett gave an insightful snapshot of the challenges faced by Medicaid programs and vendors. These challenges are diverse, and all are impacted by program design and IT support systems.

How does it work?

Tue, 17 Sep 2019 15:52:00 GMT

The goal of this article is to summarize how HCn3D uses Reinforcement Learning to identify potential outcomes without getting too technical by delving into machine learning functions and algorithms. We won’t be trying to make the reader a “data scientist” or AI expert.

N of 1: Cube as a Protected Space

Wed, 03 Jul 2019 09:35:00 GMT

Health Care in 3 Dimensions’ “Cube” is a solution for redirecting health care to changing behaviors. The interest in Artificial Intelligence as applied to health care is growing and expresses the concern if not amazement that technology has had little impact on major national policy goals of access and cost containment.

CMS AI Health Outcomes Challenge

Thu, 30 May 2019 19:14:00 GMT

The Solution for the AI Challenge must be a catalyst for a new theoretical framework. Risk stratification alone will not afford options for actions that will achieve the desired outcomes. Health Care in 3 Dimensions provides the framework to apply theory to practical problems such as reduction in unplanned admissions. This approach will resonate with family physicians and can be tailored to them as the target audience for AI.

How Can Broad Based Population Data be Useful?

Fri, 17 May 2019 17:29:00 GMT

The push for new ways to use big data is impacting Medicare and Medicaid plans. Artificial Intelligence is poised to enter the health care arena, and CMS has proposed the AI Health Outcomes Challenge as a contest to incentivize big data specialists to engage the Healthcare Commons. The idea is that tools such as machine learning and Bayesian neural networks can identify actionable structures in data to assist the CMS Innovation Center in testing innovative payment and service delivery models. Part of the contest is to make broad based data available from the Medicare Claims Dataset. The idea of making more CMS data available to the provider community is gaining currency.

A pathway for burnout: From physician engagement to Emancipation or Estrangement

Mon, 13 Aug 2018 12:42:00 GMT

All discussions of payment reform require an alert and attentive provider community. Physician burnout is clearly an impediment to this attention. It is estimated that 50% of physicians either have, or are at risk for burnout. The manifestations are protean and apparent to families of the providers and coworkers in the workplace. Not only do the effects impair patient management, but the willingness and enthusiasm to participate in health care reform to guide the engagement pathway from estrangement to emancipation. The Innovation Initiative and the Tenncare Episode of Care model, illustrate a successful program that is an ideal vehicle to accomplish this and show the way to more comprehensive models that will emancipate physicians.

Critical Realist Interpretation of Holism/Reductionism

Mon, 02 Jul 2018 15:05:00 GMT

At the heart of the critical realist interpretation of cost containment is to understand the difference in two patient centered approaches to data analytics. The reductionist approach is structured, and the holistic approach is agnostic to how the data is accumulated, or in realist terms the latter approach is open and unstructured. Putting the patient back together again requires a free form method where there is no reason not to draw conclusions from patient centered data because of concerns about statistical significance at the population level. Being unstructured the patient level data can create populations that reflect the holistic approach, in a bottom up method. This is an inversion of the top down approach in the reductionist method that characterizes patients as averages of the predetermined population.

Episode of Care Tenncare, Revisited

Mon, 16 Apr 2018 12:12:00 GMT

TennCare has released participant commentary on its Technical Advisory Groups. If you are unfamiliar with TennCare’s Episode of Care Program I’d encourage to view TennCare’s Introduction to TennCare Technical Advisory Groups and read my January blog Episode of Care Tenncare which discusses its success and potential to be a model for other Medicaid programs just as it has been for Tennessee’s CMS Innovative Initiative.

Care Coordination and Technology Congress

Thu, 15 Feb 2018 17:39:00 GMT

This Congress was an assembly of seven summits. These included: Care Coordination and Transitions, Connected Health: RPM and Telehealth, Bundled Payment, ACO Population Health Management, Merit-Bases Incentive Payment System (MIPS), Health Plan Chronic Disease Management, Provider Strategies on Community Health and Social Determinants of Health.

Time of Many Languages

Sun, 11 Feb 2018 16:13:00 GMT

I consider the present phase of health care the time of Babylon, the time of many languages; the next the enlightenment where the healthcare communities look outside of their comfortable boundaries to understand context. The next is the phase of modernity where the high dimensions inherent to HCn3D are presented to all players in simple understandable ways.

Episode of Care Tenncare

Mon, 22 Jan 2018 17:07:00 GMT

As a local State program, Tenncare under the leadership of The Medical Director Dr. Vaughn Frigon, with the assistance of the McKinsey consulting team, has demonstrated exemplary success and is a model for other Medicaid programs. The secret of their success has been careful physician engagement in episode details, due to given the design of the State of Tennessee's program, and transparency of information. Given the success of the episodes program, the question arises of what can be done next?

Pyramid of Value

Mon, 18 Dec 2017 17:28:00 GMT

An important game changing article that puts Value in a new light is in the NEJM Dec 21, 2017 issue by Green and Loscalzo. The title is "Putting the Patient Back Together - Social Medicine, Network Medicine, and the Limits of Reductionism". Many widely known and emergent tools are explained that can bear on the current understanding of Value in the healthcare context. Most importantly this article shows how holistic patient centered approaches are not only cool, but doable and can be effective in achieving a broad range of goals on behalf of patients and populations.

Taking Aim at Burnout
“If the physician is not happy the patient is not happy.”

Wed, 29 Nov 2017 19:00:00 GMT

The PCMH Congress met for the third time in Orlando (Nov 3-5 2017); the program is catching on, there are now about 1000 accountable organizations of record, including ACA's and PCMH's.

The PCMH is the Key.

Tue, 31 Oct 2017 12:58:00 GMT

I will be presenting the “Pyramid of Value” in the Poster Hall of the 2017 PCMH Congress, November 3rd & 4th, Regency Ballroom, Hyatt Orlando Florida.