Dr. Richard Gilfillan Named New Acting Director of Innovation For Medicare and Medicaid–Hope To Repair Some Broken and Non Ethical Algorithms in Healthcare Reform?

You certainly have to be innovative in working with insurers today, that’s an understatement and it appears this is the area where CMS is looking for some innovation as there’s a lot of work to be done and when the insurers have all the data and IT infrastructure, it’s a delicate balance. We need more than just one more software house to solve issues and that seems to be all that we are seeing out there today with everyone jumping on their cost analysis algorithms and telling us how wonderful they are, so a human touch to balance would be nice to bring patient care back in line.

From the website:

“Founded in 1915, Geisinger is a physician-led health care system, dedicated to health care, education, research and service spanning 43 counties of 20,000 square miles and serving 2.6 million people.”

We can just hope he’s the right guy for the job and not one influenced heavily by lobbyists as we have enough of those out there. He’s the former president and CEO of Geisinger Health Plan and I hope there’s some Health IT knowledge tucked inside his head as he will need it as everything revolves around those decision making algorithms and the balance there of with ethics. Insurers live and die by the algorithms so one needs to talk their language and be aware of all their technologies as one can say whatever they want, but unless those processes are put in place with Health IT infrastructure, it doesn’t mean a thing. Lately I have had a lot better luck not listening and tuning in to the cold hard data that I see running healthcare as it is what it is. BD

Dr. Richard Gilfillan, the new acting director of the Center for Medicare and Medicaid Innovation, has quite a juggling act to perform, says Gail Wilensky.

"It is one of the most important positions in HHS because almost all of the reform of the delivery system potential hinges on this innovation center. It is as key a position as there is," said Wilensky, who ran the Health Care Financing Administration - now known as the Center for Medicare and Medicaid Services - from 1990 to 1992 and is now a senior fellow at Project HOPE, an international health foundation. "There will indeed be pushback from people who see themselves as losers in the face of this change" and the director must be "politically savvy and sensitive but still being willing to be a risk taker."

Gilfillan, who like Berwick is a physician, joined CMS in August, directing the agency’s performance-based payment policy staff and implementing programs, including the early development of accountable care organizations. Before that, he was a consultant for Geisinger Consulting Services, where health care providers and payers design and implement accountable care organizations, patient centered medical homes and bundled payment systems – all included in the health law with the hope that they will improve medical care in federal health care programs while reducing their cost.

New 'Innovation' Chief Comes From 'Model' Health Care System - Kaiser Health News