Hipaa Certificate - The Local Choice: Fill & Download for Free

Yes. And my answer may make a lot of people upset, especially since my observations will touch on more than just emergency medical services (EMS).When I was a new emergency medical technician (EMT) I assumed EMT-Paramedics (Paramedics) were gods. I mean, seriously, anyone who could read those squiggly ECG rhythms must be magical! We even called them “paragods.”Later I learned that though there are a few very good medics, the vast majority are mediocre and just get by. There is also a significant number of truly scary, incompetent medics that manage to squeak by, possibly because many systems have at least two medics respond to each call, the stronger medic usually covering for the weak medic. Very good medics are quite rare. A very few are true professionals who think with excellent logical processes based on a solid understanding of physiology and pathophysiology, while the remaining medics stumble along using a splash of real understanding coupled with memorized protocols in a sort of medicine via “rolodex” fashion, i.e. “I see this sign and hear this symptom and it matches protocol 2A, so use protocol 2A and hope that works.”PS: Not my creation, but reflective of the fear of one's incompetent peersThough the EMS Profession officially abhors this “cookbook medicine,” it’s a reality that exists due to several factors, including shortages of EMTs/Paramedics, lack of funding for longer and more thorough training periods, and competition between programs for students, the result being quality of care where, as the joke goes, “Patients survive despite our best efforts.” Later still, I realized the same holds at several levels to include nurses, physicians assistant and, to a lesser degree, physicians.On a personal level, knowing there were really bad or stupid paramedics out in the field did help me because, several times during my own program, my confidence would waver and I’d wonder if I would be able to pass. It was at these times I’d think to myself: “If so and so could pass medic school, so can I.”Perhaps the biggest systemic shortcoming in EMS in the USA is the lack of a consistent feedback loop for EMTs and Paramedics. For example, when I assess and treat a patient in the field, turn the patient over to the ER, and the patient is then treated & discharged, or admitted to the hospital, there is NO built in mechanism to tell if my actions were correct. Learning the outcome of the case, thereby helping to improve my assessment, diagnostic, and treatment skills, involves a tedious process of phone calls and often personal visits to the hospital in question to catch the right nurse while they're on shift. Much of this happens on my off-duty time.“Sorry, can’t tell you that. Its because of HIPAA you know. Click.”Complicating this are the US HIPAA laws which, though designed to allow sharing of relevant case information for training and education, are so poorly understood, hospital and medical staff will almost never give you any info unless you have a personal rapport with whichever nurse you’re talking to. In a perverse way, the system-wide ignorance of the privacy law’s intent reinforces continued ignorance, making Continuous Quality Insurance (CQI) something of a joke.To be perfectly fair, in Southern California at least, hospitals often have a single Paramediic Liaison Nurse (PLN) with the additional duty of helping curious paramedics find out what happened to a particular patient, and they can be very helpful. However, as one nurse, often saddled with a myriad of other duties, their ability or willingness to do the chasing down of any given patient’s particular outcomes is quite variable.Currently (as I write this), I'm awaiting to find out what happened to a patient. The effort has thus far required repeated outreach via text, phone calls, and emails. With any luck, next Thursday the right person will be on shift and have enough time to get me an answer. Fingers crossed!Overall, the proces is such a headache hardly any medics bother, making feedback something that happens only if something went really wrong, and the hospital thinks you're to blame.Put EMS care another way, it’s as if EMTs/Paramedics are shooting baskets at a basketball net hidden behind a high wall. You can’t see the basket, but you keep shooting for it without seeing if you’re getting the baskets or not, or how badly and in which way you’re missing.Why no one addresses this has many factors, not the least of which is the administrative headache and costs of coordinating thousands of providers with tens of thousands of health care facilities, local area governments, etc. So EMS is guided largely by protocols used by paramedics and EMTs from programs that vary WIDELY in quality and product.As a patient, your choices when it comes to EMS are much more constrained. But when it comes to other health care providers of ANY level, you truly must shop carefully because the health care field is full of incompetent providers, including among specialists.I wouldn't care so much about the wide range of competence, except in healthcare, incompetence hurts. It is responsible for an incredible volume of unnecessary suffering and unneeded deaths and disability. A Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. Keep in mind this study used data on death certificates which often use generic terminology of death, e.g. “heart failure" or “multi system organ failure” which is sort of like mechanics saying “the car broke because it didn't work,” i.e. it tells you little.Put another way, the researchers relied on what attending physicians documented as the cause of death without knowing the truth of things. Few hospitals autopsy patients anymore, meaning for many, if not most patients, the cause of death is an uneducated guess. No one argues with “heart failure” or “cardiac arrest” or “multi-system organ failure” because those are the end result of pretty much any fatal disease process.The decline in autopsies has several reasons, including reduced quality control standards, cost and possibly lack of interest, but the lack of autopsies probably robs medical personnel of invaluable feedback on pathological processes that must now be assumed rather than “proven" (insofar as an autopsy can prove certain causes of death. In 1972, almost 1 out of 5 deaths were autopsied. From 1972 through 2003, however, the autopsy rate dropped 58 percent from 19.3 percent to 8.1 percent. Although the autopsy rate has increased slightly since 2003, only 8.5 percent, or fewer than 1 out of 10 deaths, were autopsied in 2007 (Products - Data Briefs - Number 67 - August 2011).The authors from the previous study continue "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves." In other words, no one (or at least not enough people) really care, therefore, we simply don’t know, and I don’t know if we really do want to know.

If you are an “ends justify the means” kind of person, this read is not for you. If you think mandatory vaccine legislation is all about measles, this read is not for you. If you believe every sound bite uttered from the mouths of mainstream media’s news anchors is absolute truth and should be used as the basis for ranting on social media, this post is not for you. If you like to think critically with an open mind and understand the dark side of politics and big business in this country, then please read on. I was very involved in the ultimately successful effort to kill this bill, and I will tell the story that mainstream media did not report on. I will do so as respectfully as I can, and before I start, I want to make a few things clear:It is a tragedy when a child dies from or is permanently disabled by a “vaccine-preventable” illness.It is equally a tragedy when a child dies or is permanently disabled from the medical intervention meant to prevent that illness. I have experienced both in my family.I am not so much anti-vaccine as I am pro-responsible medicine and anti- one-size-fits-all, broad-sweeping medical legislation.I have zero tolerance for any politician inserting him or herself in the sacred space between doctor and patient.The “grassroots” movement behind 1312 supposedly popped up to protect our great state’s most vulnerable population (the children) from lazy, uninformed mothers who also believe the earth is flat (or any number of variations on that narrative).A pharmaceutical lobbyist whom I will refer to by her initials, SK, formed a parent group called Colorado Parents for Vaccinated Communities (CPVC) in 2017.CPVC is financially supported by vaccine manufacturers, including Pfizer and GlaxoSmithKline. SK’s lobbyist company was paid $1,000 a month directly by GlaxoSmithKline. In January 2019, the payments stopped.Also in January 2019, Colorado residents learned that another mandatory vaccine bill would be introduced during the spring legislative season by a freshman representative who is also a newly-minted ER nurse. In the meantime, SK posing as a parent in a local mom's group, admitted that the bill "belonged" to the parent group, CPVC which presents a conflict of interest since CPVC is funded by big pharma.When the bill was filed, it would ADD four new vaccines to the mandatory Colorado school schedule, three of them manufactured by GlaxoSmithKline (GSK). GSK is also coming out with their own version of the MMR (measles, mumps, rubella). In case I need to connect the dots, GSK stood to make multi-millions off the passage of this bill which could have mandated four more of their vaccines for all school children. They are good about sharing that wealth, though. Enough of it goes towards funding the campaigns of politicians who agree to advance their agenda.This is what the bill proposed in its original form:Under this bill, the BOH (board of health) would mandate all vaccines recommended by ACIP (Advisory Committee on Immunization Practices), and would have the authority to add any others they deemed as necessary without going through the due processes in place now. Currently, Colorado does not require the flu and HPV vaccines for school entry, but they are recommended by ACIP/CDC. Every school child would need to get an annual flu shot (even if it wasn’t effective that year), and every school child would need to be vaccinated against HPV (a sexually transmitted disease). In my opinion, if the government can mandate my choices regarding the sexual health of my children, I am no longer living in a free country.All exemptions submitted would have to use the CDPHE (Colorado Department of Public Health and Education) developed and standardized “certificate.” (Currently, a statement signed by a parent is all that is needed to be exempt for religious or personal reasons.) CDPHE would develop educational materials regarding the benefits of immunizations. There was no requirement that they mention the documented risks of any of the vaccinations in the materials they develop. (See vaccine package inserts for documented risks.) In order to get a religious or philosophical exemption, parents would have to read/watch this one-sided material before getting their standardized form to sign. The problem here is compelled speech. The form would likely have had some version of “I am knowingly and willingly endangering my child and other children by refusing this vaccination.” Please keep reading; I’m going somewhere with this.Medical exemptions would ONLY be allowed based on contraindications as described by the ACIP/CDC. Licensed physicians would not be able to site their personal knowledge of an individual child, or any information contrary to the ACIP/CDC, when submitting a medical exemption. Here’s one example of how that can play out: My friend’s daughter had seizures following a round of vaccinations. It was determined by her pediatrician that the seizures were caused by the girl’s unique response to the vaccinations. (Keep in mind that some people are deathly allergic to Advil. How hard is it to believe that not all children respond the same way to vaccines?) The decision was made between my friend and her doctor to delay further vaccinations and proceed with extreme caution. Her seizures do not qualify for a medical exemption under ACIP guidelines. My friend would have had to take a religious or personal exemption for school attendance, and sign off on a form saying she was endangering her own child by following her doctor’s advice. Please keep reading.Immunization and exemption data would be collected by CDPHE, the local school, and physicians. The information would be centrally stored in CDPHE’s CIIS (Colorado Immunization Information System). Demanding a child’s data be stored in this state database is a violation of privacy under the laws governing a child’s educational and health data (FERPA and HIPAA). Let me say this succinctly: taking a religious or personal exemption (even for seizures) would result in that child’s LOSS OF MEDICAL PRIVACY RIGHTS.**Religious and personal exemptions must be submitted in person and signed by a representative at CDPHE or local health department.Fun fact: this bill had a fiscal note of zero. Medicaid would have had to pick up the cost of all the additional vaccines added to the schedule. The CDPHE would have to pay for extra hours/employees to handle all the parents coming in. Educational materials would have to be developed, printed, and distributed...all for free!Even if you are 100% pro-vaccine, wanting every shot available now, and every one that comes out in the future, no questions asked, you should still see some obvious flaws with this bill.Literally thousands of parents (mostly mothers) banded together to fight against HB19-1312. They came from every conceivable background, and held beliefs running the spectrum from “100% no vaccines ever for my children” to “I’ll take all of them, but this legislation makes me uncomfortable.” There were Democrats and Republicans, Christians and Athiests, acupuncturists and medical doctors, teachers and homeschool parents all coming together to fight what my own pediatrician called, “that horrible vaccine bill.” It gave me just a little bit of hope to know that humanity can and will unite and drop their petty differences when faced with a crisis of this magnitude.HB19-1312 represented so much more than mandating vaccinations for school children. It set the precedent that the government in some way owns your children. It takes away a basic right to bodily autonomy. (Shall we re-visit the Nuremberg code?) It starts our society down a very slippery slope. Had a similar bill passed in Oregon, children like my friend’s daughter with the seizures would have basically been put on a form of house arrest, not being able to be present “anywhere where school children congregate.” That is frightening to me. It should be to you.One day at the capitol, I stood in line next to a precious mama whose family came here from Cuba. She drove for hours with her two disabled children to sign up to testify for the senate hearing because that is a freedom her family was denied before they came to the United States. She wanted her children to understand how important it is to protect our freedoms, and that the vaccine legislation being heard that day in her opinion (and mine) was a subtle yet severe infringement on very basic rights we’ve heretofore enjoyed in this country. She cried as she told me, “This is why we left Cuba. I can’t believe this is happening here.” She never got to testify. The powers that be cut our time to two hours, which added up to about 30 testimonies out of the hundreds that were willing to stay as long as necessary to have their voices heard. Ironically (??), exactly 30 people showed up to testify in favor of the bill. Every single one of them was heard, including a very young “pharmaceutical scientist” employed by AstraZeneca and whose specialty is in respiratory devices. She told the senators, “Their emotions are real; their injuries are not,” and with that simple and arrogant statement, hoped to nullify the impact of all who gathered in opposition.I will leave you with a few more thoughts:First, a quote from the New York Times: “In the largest settlement involving a pharmaceutical company, the British drugmaker GlaxoSmithKline agreed to plead guilty to criminal charges and pay $3 billion in fines for promoting its best-selling antidepressants for unapproved uses and failing to report safety data about a top diabetes drug, federal prosecutors announced Monday.”Vaccine manufacturers have been liability free in the United States since 1986. I do not believe for one second that a criminal corporation like GSK has found Jesus only when it comes to vaccines, a product for which they have zero accountability for if it harms your child.Toilets and sewer systems did as much for the eradication of certain diseases as vaccinations did. God bless civil engineers. They should make more TV shows about you, and fewer about doctors.The actual science is not settled. Anyone who says it is, must have no respect for real science, and way too much hubris for my taste. Unless you can have a meaningful and respectful conversation with me about TH2 shift, insertional mutagenesis, the emerging field of epigenetics, and the critical differences between ingestion and injection when it comes to substances such as aluminum, you have not done your homework regarding vaccines.There has NEVER been a double-blind true inert placebo safety study done. The entire schedule has never been studied as a whole. Even meaningful studies about combining vaccines into one injection have never been done. The safety trial on GlaxcoSmithKline’s MMR was a non-inferiority study. That means all they had to prove was that their vaccine was not significantly less safe than Merck’s MMR II. Lies, damned lies, and statistics. Read the study results and tell me that vaccines are safe and effective for all children all the time.I really hate the term “anti-vaxxer.” It implies an all-or-nothing, throw the baby out with the bath water kind of approach. I am simply a person who thinks for herself and does her own research. I actually support smaller pharmaceutical companies like Sound Choice who wish to bring more ethical options to the market now dominated by greedy businessmen with no regard for true health whatsoever. We need to find a better way -for the sake of our children- and it will never happen if we aren’t intellectually honest about what is really going on in the world of politics, big pharma, and the changing landscape of pediatric illness.**For Colorado residents who were confused on this deceptive issue, “opt-out” of CIIS database applies to “immunization information” but not “exemption data.” There is no way to totally opt out your child’s exemption data from this database. When one does opt their child out of the immunization database, that child is not removed from the system, instead that child is put on the list of those objecting to having the information available. Furthermore, even though this information is supposed to be confidential, it is available to all school health officials, doctors, hospitals, and health departments. There is no way to know -and no limits on- how this information could be used. How much do you trust your government? (Thank you to CHCA & CHEC for providing this information.)

The American health care industry wastes $1T by some estimates, and possibly as much as 30% of health care spending by others. US health care expenditures are twice the OECD average – for instance, we spend twice what the UK does on health care (as a percentage of GDP) – and American health care costs are growing at 5% a year.Healthcare presents one of the greatest policy challenges for our country because profit incentives and care for the patient are often misaligned. It’s clear that the government is going to play some role in making sure the least well-off Americans have access to medicine, but we need healthcare policies that incentivize providers and payors to educate patients to make informed, data-driven choices. Only intelligent consumer choice will stimulate functioning, competitive markets in insurance, patient care, the pharmaceutical industry, and elsewhere. Today, pharmaceutical companies, health providers, electronic health record (EHR) systems, and other actors often have misaligned incentives and fail to enable more efficient solutions that do more for the patient per dollar - indeed, often the winners in these areas are those that unnecessarily charge more. Aligning incentives will spur top technology startups to develop innovative healthcare solutions, bring down costs, and deliver superior outcomes to American patients. Here are a few necessary reforms:Medical SchoolsExperts project a total physician shortfall of between 42,600 and 121,300 by 2030.* We need more medical schools fast, but the Liaison Committee on Medical Education accreditation process takes 8 years on average and most states require new medical schools to obtain a “certificate of need” before beginning construction. In addition, medical schools are required to sustain the high overhead of medical research rather than focusing exclusively on training doctors, and inflexible requirements prevent medical schools from experimenting with new curricula. Organic chemistry and other undergraduate prerequisites are completely irrelevant to becoming a good practicing doctor, and should be optional.High medical school costs force students to become high-earning specialists, e.g. plastic and orthopedic surgeons, when our country really needs more primary care physicians (PCPs). Primary care physicians, nurse practitioners, and physician’s assistants are far cheaper than specialists, but limited medical school and residency supply as well as occupational licensing concerns keep them out of the market. In addition, foreign doctors are almost always required to complete a full residency before being allowed to practice in the United States. Given a current skills gap of 30,000 doctors, adding 30,000 new PCPs, nurse practitioners, or physicians assistants could save $2.3B, $5.1B, or $6B in salary costs alone relative to the current mix of specialists and primary care doctors.In addition, primary care doctors achieve better health outcomes for patients than specialists by engaging in long-term counselling, tracking, and preventive care. Scholars estimate that replacing specialists with primary care physicians at a density of 1 per 10,000 population could save $931 per beneficiary a year. Adding a supply of 30,000 primary care physicians would save our country about $150-200B a year.*If implemented correctly, data-driven telemedicine can ameliorate demand for physicians somewhat. Doctors should be able to digitally prescribe most drugs, and data from increasingly sophisticated wearables will enable physicians to swiftly and efficiently diagnose patients.Reform PBMsIn 2017 the Centers for Medicare and Medicaid Services (CMS) spent $175B on prescription drugs alone, and there are currently shortages of vital drugs across the country. An oligopoly of Pharmacy Benefit Managers (PBMs) generates $200B a year in revenue by forcing drug manufacturers to pay rebates and other kickbacks in order for the PBM to place their drug on the “formulary”, or list of insurable drugs. Securing a place on the formulary is a matter of life and death for manufacturers, and by one estimate the current value of rebates and other price concessions from manufacturers to PBMs increased from $59B in 2012 to $127B in 2016.After speaking extensively with politicians on both sides, we were thrilled to see the Senate recently outlaw PBM “gag-orders” on pharmacies by a 98-2 vote. We are encouraged to see that Alex Azar’s Department of Health and Human Services (HHS) is planning to subject PBM rebates to anti-kickback law, but we would go further and require full price transparency on PBM contracts in the style of Colorado HB 1260. Although some rebate money flows to insurers, we estimate that reforming the space could save America on the order of $50B.End of Life Palliative CareAlthough discredited by hyperbolic language about “death panels”, counselling patients at end-of-life is both cost-effective and humane. 30% of Medicare expenditures are attributable to 5% of beneficiaries who die each year, and acute care in the final 30 days of life accounts for 78% of the costs incurred in the final year of life. While acute-care for the dying should obviously be available to those who want it, our country must shift to a model of counselling and palliative care at the end of life.Just having an end of life discussion with the cancer patient reduces medical costs by 35.7% on average, and given that there are roughly 600,000 cancer deaths in the United States a year, would have saved $687M a year for cancer patients in the last week of life alone! In addition accountable care organizations (ACOs) have saved $12,000 per patient during the final three months of life by implementing home-based palliative care. If extended to all cancer, end stage renal disease, and congestive heart failure patients this program could save the country $11.7B a year.We all agree that we must treat families of the dying with delicacy and compassion. But introducing a program by which families will share in Medicare/Medicaid savings from palliative care would help families and patients factor the overall social cost of end-of-life care into their decision calculus. We estimate that extending proven programs and testing different incentives structures could save our country $30-50B a year.FDA ReformClinical trials are an arduous multi-year process and have become drastically more costly in the last 30 years. Phase II and III efficacy trials cost roughly $400M per new drug, which severely limits the number of drugs that make it to the final stage of Food and Drug Administration (FDA) approval. A “progressive approval” approach would allow drugs to be repurposed for other uses and possibly sold after passing Phase I safety trials, which establish that a drug has a favorable risk balance and qualifies as value-based care. Drug companies could gradually establish efficacy by logging the effects the drug has on each person who opts to use it over the next several years.The extreme costs of clinical trials and FDA approval not only stymie drug development and the application of treatments to new indications, they effectively privilege Big Pharma over other innovators, inhibiting innovation and medical progress. A data-driven approach in which doctors and hospitals verify drug efficacy over time would allow the FDA to concentrate its resources on ensuring safety, particularly as the market for new drugs becomes sophisticated at assimilating information from the progressive approval process. While ramping up the number of drugs approved may not save our healthcare system money on net, a framework which encourages innovation will positively impact millions of lives by improving quality of care.Give Medicare Negotiating PowerTo pass the Affordable Care Act (ACA), the Obama Administration made a critical concession: Medicare would not be able to negotiate the price of drugs by controlling which drugs make it onto Medicare’s formulary. As a consequence, our federal government is a “price taker” that must blindly accept whatever prices drug companies demand, and the American government winds up subsidizing drug development costs for the rest of the world. Drug prices at home are extremely high, representing 10% of total healthcare expenditures, and about $144B of federal healthcare spending.In many other developed countries, governments use their monopsony or near-monopsony buying power to force pharmaceutical companies to sell drugs at much cheaper rates. For instance, Canada spends 70% of what the US spends on brand name drugs, the UK 40% of what we spend, and Denmark only 35%. If the US federal government used its considerably larger “countervailing power” to negotiate reduced drug prices – whether on a case by case basis or by pegging the value of a Quality Adjusted Life Year at a generous but fixed rate - savings could be in the range of $30-40B, possibly even as high as $90B a year.Pharmaceutical industry lobbyists (PhRMA) argue that high drug prices are necessary to stimulate R&D which generates many new life saving drugs every year. But in fact, median R&D spending on new cancer drugs – the most difficult to develop – is only around 40% of total revenue. In addition, most R&D is funded by American universities, and manufacturers of silver-bullet specialty drugs could continue to charge high prices to a federal payor. Giving government negotiating power isn’t a novel solution, but it’s one of the correct solutions to driving down drug costs for Americans.Tort LawThe threat of malpractice lawsuits forces doctors to engage in costly defensive medicine. Although the current administration has made some progress on tort reform (making arbitration legal for federal contractors and nursing homes), Congress must insist on Texas-style reforms including capped punitive and noneconomic damages from healthcare providers, eliminating contingency fees for speculative tort lawyers, reinforced federal preemption doctrine for food and drug products, and more. Unfortunately the trial lawyers lobby – one of the biggest political donors in the country – will fight reform at every step of the way.Some studies estimate that reducing physician malpractice fears to “somewhat concerned” about malpractice would decrease costs by 14%, saving the country $100B a year. Others argue that medical liability reform could save our country up to $210B a year. Congress must protect our doctors from being attacked by unscrupulous prosecutors in order to reduce the cost of healthcare for American citizens. We all agree that we must insist on protecting patients, but unchecked tort lawsuits just punish American patients and taxpayers with an unaffordable system.Data InteroperabilityThe ACA’s “meaningful use” requirements did little to make healthcare data accessible. As of 2015, only 6% of health care providers could share patient data with other clinicians who use an EHR system different from their own. Although 21st Century Cures Act made “information blocking” illegal, big EHR vendors routinely prevent their competitors from importing patient data by disclosing health records in garbled, incoherent formats. As a result, physicians are unable to make fully informed decisions about their patients.Judy Faulkner, CEO of EPIC, famously condescended then Vice-President Biden, “Why do you want your medical records? They’re a thousand pages of which you understand 10.” The answer is that only real, semantic interoperability which makes health data available to third parties via and open application programming interface (API) will allow an innovation ecosystem of apps, medical devices, and novel insurance plans to flourish. Granular, transparent healthcare data will allow entrepreneurs – whether college students or IBM executives – to invent new solutions from the bottom up and swiftly incorporate best practices into their businesses. In addition, direct service-to-service comparisons will allow consumers to make informed decisions about how to stay healthy, stimulating market competition for their dollars.We have been excited to see CMS’s Blue Button 2.0 API program formalize the Fast Healthcare Interoperability Resources (FHIR) standard for health records, which includes programmer resources, a complete API, and gives beneficiaries full control over their data – but EHR providers are refusing to use it. While any EHR system should ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) by storing protected health information on secure servers, we need to make interoperability truly mandatory.If patients could easily share their medical records with new providers and selectively reveal their data to health apps, fitness devices, diagnostic companies, insurers, and academic researchers, our entire healthcare industry would become hugely more affordable and effective. Reliable, real-time information about which treatments work, which failed, and what they cost will enable hospitals to identify and minimize cost centers as they strive to produce care more cheaply than federal benchmarks and share in the savings.Financing ReformOvertreatment and poor physician incentives may be the main driver of health care costs. Most hospital networks are local monopolies with limited incentives to innovate or save money. Replacing this broken system with value-based care models will immediately save over $100B in total, and should grow steadily over time to $200-300B as doctors harness digital technology interventions and other new techniques to make care cheaper and more effective. We break down a few potential sources of savings below:Bundled PaymentsThe Bundled Payment Care Initiative (“BPCI”) introduced in 2013 shows serious promise in making acute care clinical workflows more efficient, particularly in orthopedic care and oncology. Results continue to improve as providers adapt to the program.After adopting a bundled payment model, the NYU Medical center reduced costs to Medicare by 10% and reduced patient stays by 25% for total hip arthroplasty procedures, and a private practice joint arthroplasty generated 20% savings for CMS per episode while decreasing readmissions. The Congressional Budget Office estimates that a voluntary bundled payments system could save Medicare $6.6B a year. If CMS makes bundled payments mandatory for both Medicare and Medicaid, achieves health record interoperability, and allows the ecosystem to iterate on data-driven incentives, we expect savings to surpass $100B.Accountable Care OrganizationsACOs are widely seen as the Affordable Care Act’s main instrument to rein in health care spending, and ultimately we expect that bundled payments will be folded into a broader ACO model. To date ACOs have generated modest savings on average, but some, such as the Memorial-Hermann ACO, have generated 11% savings for Medicare. ACO contracts are more efficient if they involve two-sided risk (rewards for savings, penalties for overages), but studies have shown that even early versions of upside-risk only ACOs are associated with a 3% reduction in Medicare reimbursement. In addition, Medicare ACOs have improved quality measures across the board, despite their old, sickly populations.Provider networks are still adjusting to the ACO model, and returns will increase in the future. Projecting savings at 5-10% and assume that all Medicare beneficiaries are enrolled in ACO providers, ACOs would save Medicare $30-60B a year. If extended to Medicare and Medicaid, full ACO enrollment could generate between $56-112B a year.Preventive MedicineThe ACA now mandates coverage for all evidence-based prevention in non-grandfathered plans, so preventative screening and vaccinations have increased since the advent of Obamacare. However we need to drastically increase the scope of preventive medicine under the aegis of value-based care. Preventable chronic diseases are 7 of 10 top causes of death in the country, and account for 75% of health care costs. Half of American adults have chronic disease, and surprisingly, chronic illness among those younger than 65 years accounts for 67% of total medical spending. 70% of American adults are overweight, and 1 in 3 American kids and teens is overweight or obese. Prevalence of obesity has tripled since 1971.Some of the most cost-effective, successful preventive health interventions include childhood immunization, youth and adult tobacco counselling, alcoholism interventions, aspirin use for people with heart disease, and screenings for common cancers, STDs, and chronic conditions like hypertension. Evidence suggests that many other preventive health interventions are cost-neutral or increase long-term medical costs (because they extend lifespans). However critics often miss the fact that preventive health measures will extend the working careers of Americans, and pay for themselves in the long-run.In kidney care, for example, the federal government subsidizes extremely costly dialysis treatments for end stage renal disease patients but has not crafted incentives to perform preventative treatments before a patient advances to this critical, debilitating condition. Rather than fill the coffers of the corrupt duopoly that runs the dialysis industry, we should give providers incentives to halt the progression of kidney disease in its tracks. As a country we spend $42B on hemodialysis. Just getting prevention right here could save our system north of $10B a year.ConclusionFixing our sprawling, tangled healthcare system is one of our nation’s greatest policy challenges. In the coming years, America should move swiftly to embrace value-based care models which align market incentives to produce a wealth of patient data and an ecosystem of new information technologies geared at preventive treatment. At the same time, we must address specific areas where poor incentives have throttled the production and delivery of medical services. Replacing bureaucratic mandates with proven Western values of entrepreneurial innovation and educated individual decision-making will yield better patient experiences and results for Americans from every walk of life while saving our country $600-$900B annually – a transformative amount of money for the well-being of our nation.