I have been a follower of Paul Grundy for a while. I first wrote of him in 2008 (the year that I first met him). In 2009, I posted a link to his slides regarding the US healthcare “system” and also wrote of an effort he made to transform Alabama healthcare delivery. I went to the Alabama Rural Health Conference in Tuscaloosa this week and heard him again today. He is a compelling speaker and plugged into the federal level  transformation.  He believes in the system he is trying to get American’s to purchase. He claims that the Accountable Care Act  ACO section was written to allow the Patient Centered Medical Home to be operationalized. It only requires the capacity to care for 5000 Medicare lives which means that a reasonable small primary care office could qualify. In his talk he points out that Denmark has transitioned from 122 hospitals to 20 hospitals and the bulk of the care is done in the PCMH using enhanced home monitoring and proactive rather than reactive care. His other major point is that the PCPCC is a collaborative arrangement that includes large employers and government payors so there will be no repeal and replace…they like the bill and the rules are going to be written and so ingrained that care delivery will be changed forever no matter how many conservative Republicans think otherwise. He point to the VA and DOD efforts as proof positive. Private groups are consistently demonstrating a reduction in cost of 10% or more. Threatening if you make your money off of third-party administered claims (as does BC/BS of Alabama)… 
 
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