In his State of the Union speech before Congress last night, President Trump stated, “I’ve also made an ironclad pledge to American families. We will also protect patients with pre-existing conditions.”

I have come to judge politicians not by what they say (not that that is not important), but what they do. Using this framework, I would have to say that President Trump, his administration and Republicans in the Senate are not keeping this pledge and quite the contrary, have actually made efforts to significantly weaken protections for patients with pre-existing conditions.

First of all, let’s understand what the issue is and what some of the associated insurance terms mean. The Centers for Medicare and Medicaid Services (CMS) estimates that 129 million Americans, or basically 1 of every 2 Americans, could be denied affordable health insurance based on pre-existing conditions without the protections of the Affordable Care Act (ACA) or group insurance, such as employer-sponsored insurance. This could happen in plans that are not ACA-compliant through a process called underwriting.

For those of us old enough to remember, before the ACA, we would have to answer a number of questions about our health in an application for insurance coverage. Together with a review of medical records, insurance companies could then deny coverage, exclude coverage for the pre-existing condition, provide for a waiting period of say a year during which claims related to the pre-existing condition would not be covered and/or charge significantly more in premiums to cover the pre-existing condition. Many people were unable to get insurance coverage or obtain coverage at an affordable rate if they had a pre-existing condition. This then meant that their underlying condition(s) went untreated, the person got treatment, but then went into significant debt or even bankruptcy or the patient depended upon charity care or Medicaid once they went through their assets to pay for care as long as they could.

When dealing with pre-existing conditions, there are two phrases that are important to understand. Guaranteed issue means that insurance coverage cannot be denied based on your pre-existing condition(s). Guaranteed issue is a requirement of ACA-compliant plans. But, if insurance companies were merely required to accept everyone with pre-existing conditions, they would then adjust your premiums to account for the increased risk of loss (payments by the insurance company) related to your pre-existing condition. For many with pre-existing conditions, this insurance coverage would be unaffordable.

So, this is where community rating comes in. Community rating, another feature of the ACA, requires that premiums be offered that do not vary with the illness burden that an individual has, but rather is tied to the geographic area in which the person lives. For example, insurance coverage will, in general, be less expensive in the mountain states than on the east coast of the country because of the higher cost of living and therefore higher wages that have to be paid to health care workers on the east coast compared to in the mountain states. But a person with diabetes would not be charged a higher premium for the diabetes regardless of where he or she lives. The only factors the ACA allows for insurance companies to use to factor into premiums beyond where their insureds live are age, gender and smoking.

Here is why I come to the conclusion that the President, his administration and Republicans are not acting consistent with the President’s pledge and his comments in the State of the Union address:

• Texas v. U.S. I have written about this case on my blog. It is a case brought by 20 Republican states challenging the constitutionality of the individual mandate, and in turn, the entire ACA, after Congress reduced the penalty associated with the individual mandate to zero in the 2017 Tax Cuts and Jobs Act. It is not essential to review these constitutional issues here to make my point.

If the Republican states are successful in their challenge (and so far, they have been in the federal district court, with a decision that the individual mandate is unconstitutional being affirmed by the U.S. Court of Appeals for the Fifth Circuit), then the key provisions of guaranteed issue and community rating may also be struck from the ACA if the courts ultimately decide that the individual mandate is integral to these provisions. I predict that the federal district judge will conclude that is the case (though I believe that is a legally incorrect conclusion), but I do hold out hope that the U.S. Supreme Court will conclude that the individual mandate can be removed from the ACA without the need to strike down other provisions of the ACA.

So, what does President Trump have to do with this? Well, in the overwhelming majority of cases, the Department of Justice defends existing laws from constitutional challenges. There are exceptions to be sure, but they are quite few. Generally, on those rare occasions when the Department of Justice does not defend the constitutional challenge, it is because the current administration is very opposed to the current law on political grounds. For example, the Obama administration’s justice department did not defend a constitutional attack on DOMA – the Defense of Marriage Act – due to political objections to its provisions.

The Department of Justice has not defended most of the challenge against the individual mandate, and in turn, the ACA. Certainly, President Trump and many Republicans in Congress have not made a secret of their disdain for the ACA.

Because of the Republican states’ challenge that not only is the individual mandate unconstitutional (an argument with which I agree), but that as a result the remainder of the ACA must also be struck (an argument with which I strongly disagree from not only a legal analysis, but also with respect to the severe disruption this would cause to the American health care system – the topic of a future blog post), the failure of the Department of Justice to make a full-throttled defense to preserve the remainder of the ACA other than the individual mandate, and especially to fail to defend the law without a viable alternative in hand that could pass the House and Senate and be signed by the President, is a display of the administration’s contempt for the ACA without an equal concern for the well-being of the huge number of Americans who would then lose the protections of guaranteed issue and community rating.

• On July 28, 2017, Senate Republicans voted to repeal “Obamacare,” but were thwarted by Sen. John McCain’s now famous thumbs down “no” vote. Though they came dangerously close to repealing the ACA, once again, they had no viable alternative capable of gaining enough support to be enacted by Congress that would protect guaranteed issue and community rating. Had Republican Senators been successful in their repeal effort, millions of Americans with pre-existing conditions would likely have lost their insurance coverage, and for some, perhaps their lives.

• Despite President Trump repeatedly proclaiming that Republicans would be the party of health care and that he would roll out a new health care plan that would be far better and protect those with pre-existing conditions, no such plan has been put forth, and in fact, the President has indicated there will be no such plan until after the 2020 election. Given that health care is the number one issue for voters, one would think that if a great plan existed, Republicans and the President would want to tout that during the 2020 campaign.

• Another action that threatens coverage for those with pre-existing conditions is the administration’s push for short term plans and other non-ACA-compliant plans, such as association health plans. While less expensive, these non-ACA plans do allow for underwriting and generally have fewer covered benefits – two features that work to dissuade those with pre-existing conditions from purchasing them. The problem is that these plans do attract younger and healthier individuals that then takes them out of the risk pools with older individuals with pre-existing conditions, which in turn, causes premiums for plans that cover pre-existing conditions to go up and become less affordable for those who need coverage for these illnesses or disabilities.

So, certainly, I cannot come to the conclusion that Republicans are the party of health care. Rather, I think the current President and Congress have done more to harm health care coverage for the most vulnerable more than any other administration I can think of. Further, rather than carrying out an “ironclad pledge” to protect people with pre-existing conditions, the current President, administration and Republicans in Congress are the single biggest threat to continued protections for those with pre-existing conditions.

Now, before you conclude that I am a “never-Trumper” or Democrat, neither of which is true, let me say that while Democrats have scored high in my book for protecting those with pre-existing conditions, I have plenty to fault Democrats on their health care policies, as well. In fact, I will be getting to that, probably in my next blog piece.

It has become increasingly clear to me that Washington D.C. is broken and unlikely to fix health care. That means it falls upon us in the industry to fix it. Unfortunately, there are few health systems, insurance companies or physician groups willing to take the financial risks and do the hard work it would take to transform health care.

St. Luke’s Health System is one of those health systems actively working to transform health care and fix it – provide unparalleled quality, move from fee for service to full risk arrangements, improve access and improve affordability. That work began under my leadership of the health system and will now continue under the new CEO, Chris Roth. While we acknowledge that Washington is unlikely to fix health care, all we ask is that Washington not get in our way of fixing it. That means protecting affordable coverage for those with pre-existing conditions. Loss of protections for those with pre-existing conditions will mean poorer health outcomes, more bad debt and more charity care – all things that we will have to react to and deal with rather than doing the work we have embarked on to transform health care.

Everything You Need to Know about the Wuhan Coronavirus (2019 Novel Coronavirus (2019-nCoV))

What is a virus?

A virus is a small (you cannot see a virus with the naked eye) infectious agent that cannot replicate itself without infecting a host cell. But, once a virus infects a suitable host cell, its genetic material can replicate and dramatically increase the amount of virus in that host (the viral load) as it spreads through many other cells of that host. How severe the viral infection will be in humans often depends upon the age of the person who is infected, the general health of the person infected and how strong the immune system of the person is. There are viruses that are relatively harmless to adults with normal immune systems, but that can cause severe disease or death in children with certain forms of immune deficiency.

There are many types of viruses. Some cause infection in humans; others do not. Of those that do infect humans, they all vary in terms of how contagious they are (how easily transmitted from one person to another), how they are transmitted (through the air, through an animal bite, through close contact, through exposure to bodily fluids, or through sexual contact), how easily they are transmitted (e.g., the measles virus is unusual in that it can remain contagious in a room long after an infected child has left the room, while most other viruses will require closer contact), and what parts of the body they primarily attack and how they are manifest (e.g., skin (rash), upper respiratory tract (coughing, sneezing, runny nose), or central nervous system (meningitis, encephalitis)). Viruses that infect humans have varying incubation periods, i.e., the period between the time of exposure to the time of illness. Generally, these incubation periods are a number of days, but can be weeks, and in the case of some viruses, e.g., the AIDS virus, the incubation period can be months to years.

There is not a cure for most viral infections. Generally, we provide supportive treatment – ensuring that the person maintains sufficient fluid intake, managing symptoms and often providing some sort of isolation of the patient or protective measures for caregivers and visitors to try to minimize the spread of the virus. In most cases, if the infected person has a normal immune system, it will ramp up to attack and kill the virus and rid the body of the infection.

However, we do have immunizations for many viruses that provide varying degrees of protection from getting infected with the virus in the first place and that help create a sufficiently large population of people who are immune and not particularly susceptible to the virus (herd immunity) that even if someone does get infected, human-to-human spread will be minimized and not cause an epidemic.

We do have treatments for some viral infections. These anti-virals are typically drugs that impair the ability of the virus to replicate, allowing the body’s own immune system to rid itself of the virus.

What is a coronavirus?

Coronaviruses are a type of virus that are grouped together because of common features. They were first identified in the 1960s and up until 2002, there were four known strains that caused infection in humans, and all of the illnesses associated with coronavirus up until that time were relatively mild, causing cold-like symptoms. These viruses got their name from the spikes on their surface, which when viewed under special microscopes resemble a crown (the Latin word for crown is coronam).

When and why did the new, much more severe strains of coronavirus emerge?

The four, relatively mild strains of coronavirus involved human-to-human transmission. The three severe strains of coronavirus that emerged since 2002 all appear to have been transmitted from animals to humans. Two of these strains emerged in China and one in Saudi Arabia. There is speculation, and mounting evidence, that these new threats may be due to markets that sell exotic animals for human consumption that keep the exotic animals in close confinement and in some cases, poor sanitary conditions. Epidemiological evidence and DNA sequencing of these new viruses can help us trace the origins of these infections.

In November 2002, a new strain of coronavirus (SARS-CoV) was first recognized in China, and it subsequently caused a world-wide outbreak in 2002-2003 with 8,098 identified infections, resulting in 774 deaths. The illness was named severe acute respiratory syndrome (SARS).

In 2012, a new coronavirus strain causing infection was identified in Saudi Arabia. That illness was called Middle East Respiratory Syndrome (MERS) and the virus was named (MERS-CoV).

The current seventh strain of coronavirus was identified by Chinese officials on January 9, 2020 while investigating an outbreak of pneumonia in Wuhan City, Hubei Province, China that began in December 2019. This new virus is named 2019 Novel Coronavirus (2019-nCoV). Epidemiologic studies have connected many of the initial cases to a particular market in Wuhan City that sells exotic animals for human consumption. Many viruses that can be transmitted from animals to humans are not easily then transmitted from human to human. However, because many of the early cases had no connection to this exotic animal market, it is believed that human-to-human transmission is now accounting for the majority of cases, especially since the market has been closed and cases continue to emerge.

Early DNA sequencing studies are ongoing, but it appears that the 2019-nCoV came from a bat. Because the time of year was not one that would be associated with much bat activity, it is suspected that a bat transmitted the virus to an intermediate host (another animal) that in turn infected humans. The SARS-COV was determined to have been transmitted to humans through civet cats and the MERS-CoV through camels. The early evidence also suggests that the 2019-nCoV may have emerged from a virus related to SARS.

How does human-to-human transmission of the 2019 novel coronavirus occur?

Transmission appears to occur when an infected person coughs or sneezes and spreads the virus in droplets through the air to other people who are in close (within about 6 feet) proximity. We believe that these droplets then land in the nose or mouths of a healthy person, and these droplets can then be inhaled into their lungs, setting up infection in a new person. It is not known yet whether this virus, like some others, can survive for any period of time on surfaces following an infected person’s cough or sneeze and then be passed on to a healthy person by them touching the surface where the droplet has landed and then placing their hand to their mouth or nose, and recently, there has been some cause for concern that the droplets might be able to transmit the virus through contact with a healthy person’s eyes.

How contagious is this new virus?

We simply do not know yet. There is some reason to believe that the risk of human-to-human transmission is still low and may require sustained, prolonged, close contact with the infected person. This is in large part, due to the fact that we have not seen a lot of cases within families. However, we just recently observed the first two instances of transmission from a patient to a family member in the U.S. and it was after such prolonged, close contact.

What is the incubation period for this virus?

The period of time from exposure to the onset of symptoms appears to as short as several days and as long as 14 days. The concerning news is that it appears that people can be contagious prior to the onset of symptoms. Unfortunately, before that was known, passengers arriving from Wuhan, China were screened for fever and other signs of illness, but then admitted into the United States if negative. Unfortunately, we now realize that it is possible some of these travelers might still be infected and contagious, even if they did not have fever or report symptoms.

What are the symptoms of 2019-nCoV?

Infected people have ranged between mild cold-like symptoms to severe respiratory illnesses, including fever, cough, shortness of breath and pneumonia.

How serious is the infection?

While the statistics are likely to change (for the better) as we get better at identifying these cases, it appears that 20 percent of those who become ill will develop severe illness and perhaps about two percent of those who become infected and symptomatic will die. However, these numbers are very unreliable at this stage of investigation. It could be that we are missing many mild cases, which will make both of these statistics over-exaggerated. As of the time of this writing, only one death has occurred outside of China (Philippines).

How many cases of 2019-nCoV are there in the United States?

This is a constantly evolving number, as we are early on in the transmission of this disease. Some people are suspected to have this illness and have been tested, but test results are not back yet.

The United States has declared a public health emergency. This means that non-U.S. citizens who have been to China within the past 14 days are banned from entry into the U.S. and federal funds have been released to assist the Centers for Disease Control (CDC) and other public health agencies monitor, assess and control this public health threat.

World-wide, there are more than 17,000 confirmed cases of this infection. Most of these are in China. There are now eleven confirmed cases in the U.S. and another 82 patients undergoing testing. The test is not available other than through the CDC, and therefore there is a considerable time lag between testing and obtaining results.

So far, the states that have one or more cases of identified 2019-nCoV cases are Arizona, California, Illinois, Massachusetts and Washington. At the time of this writing, there are no cases in Idaho.

Should I get tested for 2019-nCoV?

Keep in mind that we are in the middle of cold and flu season. If you have cold-like symptoms, the overwhelming likelihood is that you have a cold or perhaps the flu.

The only reasons for us to be concerned and test you for 2019-nCoV would be that you have traveled to China in the past two weeks or someone with whom you have close contact has traveled to China in the past two weeks.

Texas v. United States

I have written about this case, a huge existential threat to the Affordable Care Act (“ACA”), on a number of occasions. Even before this case attracted much media attention, and even though many legal scholars dismissed the challenge as being very weak, I was advising readers of my prior blog to take notice and follow along, as I believed it was a sleeper and had a very significant likelihood of success.

Republican attorneys general and governors of 20 states (Idaho is not a party to this suit) brought a constitutional challenge to the individual mandate (the provision that requires that people, with some exceptions, maintain ACA-compliant health insurance or pay a penalty) after Congress reduced the penalty to $0 in the 2017 Tax Cuts and Jobs Act.

The ACA had withstood a constitutional challenge in 2012 when the U.S. Supreme Court agreed that the mandate to purchase insurance could not be sustained under the Commerce clause or the Necessary and Proper clause of the U.S. Constitution, but ruled that the individual mandate was a constitutional act of Congress based on its taxing power. The Court construed the penalty to be a tax to save the ACA from being ruled unconstitutional. Key to that finding was the fact that the penalty raised revenue for the government.

After the penalty was reduced to zero, those challenging the law argued that it could no longer be construed as a tax. Because Congress has no constitutional power to compel Americans to purchase something, if this penalty is no longer a tax, the provision is no longer constitutional. The district court judge who heard the case agreed.

When a provision of a law is unconstitutional, courts must determine whether the illegal provision can be severed from the law, allowing the remainder of the law to stand without the unconstitutional provision. Separation of powers calls on courts to preserve laws passed by Congress when possible, but the judge in this case determined that the individual mandate was so integral to the law as a whole that the ACA must be struck down in its entirety.

That precipitated an appeal to the U.S. Court of Appeals for the Fifth Circuit (“Fifth Circuit”), and a panel of Fifth Circuit judges ruled 2-1 to affirm the lower court’s ruling that the individual mandate was unconstitutional but that the judge’s severability analysis was not thorough and exacting enough. The court of appeals remanded the case (sent the case back) to the lower court judge to go through a provision-by-provision analysis to determine which portions of the ACA must also be struck down, which may or may not result in the same conclusion as his original ruling.

The court of appeals’ ruling that the individual mandate was unconstitutional was not a surprise. It had been my hope that the court would, in so ruling, determine that the remainder of the ACA was severable and allow the ACA to stand without the mandate. This would preserve guaranteed issue (people cannot be turned down for insurance based on pre-existing conditions) and community rating (people cannot be charged more because of their pre-existing conditions).

At the time the ACA was enacted in 2010, it was understood that the mandate would be critical to ensure that insurance companies could have a sufficient risk pool if they could not deny those with pre-existing disease and could not charge more for them. The logic was that many more insured would be needed, particularly the young and healthy who could help subsidize care for older and sicker individuals through their premiums.

It was a reasonable policy, but what became clear with time was that the carrots – advance premium tax credits and subsidies – were likely more persuasive than the stick – the individual mandate’s penalty. Even after the penalty was reduced to zero, ACA plans have remained fairly stable in enrollment (preliminary numbers suggest that enrollment for 2020 may only be down about 2 percent from last year and that last year, premiums went up by only about 5 percent attributable to removal of the mandate’s penalty).

Senators and representatives have suggested that when the penalty was reduced to zero in 2017, there was not a belief that this would upend the ACA; part of the criticism of the district court judge was that he seemed to place his emphasis on the intent of the 2010 Congress in enacting the ACA (strong belief that the ACA could not function without the individual mandate), as opposed to the 2017 Congress that zeroed out the penalty (when there was much less concern that the ACA could not function without the penalty).

The Trump administration is largely not defending the law, and Republicans have no replacement bill that can pass both chambers of Congress and be signed by the president in the event that the ACA is struck down. The American health-care delivery system would undergo tremendous changes if the ACA were to be struck down: People could be denied insurance based on pre-existing conditions, people who were able to get insurance could be charged more for the insurance or their pre-existing condition could be subject to waiting periods or riders, children up to age 26 would no longer be assured of coverage on their parent’s insurance policy, the prohibition against annual and lifetime limits of coverage would go away, Medicaid expansion would no longer be funded and the public insurance exchanges would no longer be funded, just to name some of the changes.

The Democratic states that are defending the ACA could take one of three actions: (1) allow the case to proceed on remand and then appeal the case again once the lower court judge issues his new ruling; (2) request an en banc hearing (a hearing before the entire Fifth Circuit); or appeal the case to the U.S. Supreme Court.

The first option would likely take a long time (perhaps a year) and would result in continued uncertainty about the survivability of the ACA and would mean the case will not be decided prior to the 2020 election.

The second option is discretionary on the part of the Fifth Circuit Court, and I doubt it would be granted. Even if the Court were to grant a hearing en banc, the Court as a whole is even more conservative in my judgment than the three judges involved in the recent ruling, and therefore, I would not expect a better or different outcome.

The third option, the option the Democratic states chose, is discretionary on the part of the Supreme Court. The Court grants very few of these requests, and I suspected that since this case has not finished running through the lower courts, the Supreme Court would be reluctant to take it up. However, it was possible that the Court would decide to grant the appeal given the magnitude of importance of this case and the fact that its current state leads to a great deal of uncertainty.

If the Supreme Court had granted the request (which would require four justices to agree to hear it), unless the Court agreed to expedited review (which would require five justices to agree), a decision would still not be likely prior to the 2020 elections. If the Court did agree to hear the case and expedite it, we could have had a decision by summer.

The Democratic states filed the necessary request with the Supreme Court, including a request for expedited review, and the Court denied the request for expedited review last week.

This was not a surprise. The only part of the decision that I believe is ripe for review has to do with the constitutionality of the individual mandate without a penalty. To me it seems clear that it is not constitutional, and it would be very surprising to me were the Supreme Court to hold otherwise.

But to me, that is not the important question. Even if the individual mandate must be struck, as I stated above, most everyone agrees that the mandate’s penalty is not necessary for the ACA to continue to operate as intended. The important question is the severability question.

If the mandate can be severed from the ACA, we are in business. Almost nothing will change. However, if it is not severable, and even if just the guaranteed issue and community rating provisions of the ACA must fall with the mandate, the American health-care delivery system will be very seriously disrupted. Because the appeals court did not address severability, we generally would not consider this issue ready for Supreme Court review. The Supreme Court certainly could decide the issue, but it would be highly unusual.

Meanwhile, the ACA continues to be the law of the land, and we enter into the 2020 election with very different views between Republicans and Democrats (and even within the Democratic party) as to how to solve our health-care challenges. Unfortunately, the national discussion is misguided. Despite the fact that health care is the number one issue for voters and their concern is how to pay for it, Republicans have focused their efforts on eliminating or crippling the ACA, and Democrats have focused on how to provide more coverage and what benefits should be included. There could not be a wider disconnect between the voters and their elected officials, and neither party has a plausible solution to our health-care spending problem. I will write more about this next week.

Be yourself; Everyone else is already taken.

— Oscar Wilde.

This is the first post on my new blog. I’m just getting this new blog going, so stay tuned for more. Subscribe below to get notified when I post new updates.

What is this blog about?

I cover important current national and state-level issues in health care – particularly health care policy and health care law. Because of the nature of the topics I cover, they are at the intersection of health care and politics.

Why is this blog important?

Unfortunately, sources of information about these important issues are often biased, come with a particular political point of view or are written or sponsored by industry interests. Of course, I have biases of my own, but I also have the ability to present an issue objectively and discuss the pros and cons of all sides of the issue so that readers can make an educated opinion on the issue for themselves. I believe that if you give readers balanced and complete information, they will be able to engage in the discussion productively and come to well-informed opinions and solutions.

Of course, there are few issues in health care that I do not have an opinion about, and there are many who, because of my background and experience, want to know how I come out on a particular issue. I will share those opinions with you on the blog, but I will be clear and explicit with you when I am expressing my own view. You can then take it for what its worth.

Who is this blog for?

Really, any one with an interest in topical health care policy and legal issues. However, there are some who may have a particular interest in this blog:

1. Health care CEOs. Health care leaders are very busy and barraged with information. They simply cannot read everything, and much of what they get is not completely objective. This is a site where CEOs can get up-to-date, important information on topics of importance to health care leaders that they can trust. As a recently retired health system CEO, I know what information CEOs need, and there are few other sources of information written by a CEO for CEOs. This is also a source of information that CEOs can use to provide important updates to their teams and their boards.
2. Board members of hospitals, health systems, insurance companies and other health care organizations. Health care is complicated. It is particularly challenging for board members who come from other industries to understand the complexities of health care. This blog can serve to keep board members informed about important issues that their companies are likely dealing with, as well as to keep them informed as friends, family, neighbors and colleagues ask them about these topical issues since they are likely aware that they serve on a health care board.
3. Students and other health care leaders. Students of health care will appreciate how complex issues are presented in an easy to understand blog. Current and future health care leaders need a good source of current information, but also a source that may challenge their thinking or help them think about current health care challenges in a fresh and new way.
4. Journalists. Health care reporters and journalists can at times be challenged to get the information and background that will really help them understand a complex issue that they must digest in very little time in order to hit deadlines and to ask interviewees the “right” questions. This blog will help them do just that.
5. Legislators. Legislators have a tough job. They have to make law about complex issues in areas of industry that they may not be expert in. To make matters worse, they are often inundated by parties and lobbyists that are interested in what is best for their business, not necessarily what is best for that state or our country. This is an unbiased source of information to help legislators understand these complex issues and the pros and cons of various positions.

Who am I and why should you trust what I have to write?

I am a physician, board certified in Internal Medicine. I practiced for ten years. I am also a health care attorney. I have taught a course titled Regulation of Health Care Professionals for about 13 years, first at the University of Houston Law Center and most recently at the University of Idaho College of Law. I have also written a text book by the same title.

I was the CEO of a large teaching hospital in the Texas Medical Center for almost four years and most recently, I was the President and CEO of a health system for a little over ten years. That health system was recognized for being a national leader in quality and for its transformation of its business model from fee for service to value (full risk arrangements).

While a health system CEO, I had a blog for about 8 years – Dr. Pate’s Prescription for Change.

How often will I post new information?

I am going to try to write something weekly. I am not going to commit to a specific day. There may be times that I miss a week. There will be others will I will post something more frequently, especially when there is breaking news. So, be sure that you are subscribed to the blog so that you receive notice when I have a new blog post. You can also follow me on twitter. I will tweet my new blog posts. My current twitter handle is @drpatestlukes, but I will be creating a new twitter handle soon given my impending retirement from St. Luke’s Health System. I will let you know as soon as that new twitter account is set up.