President’s Blog: The View from Here

  • My, How You Are Aging!

    Jul 1, 2019 | Christopher F. Koller, President

    “My, how you are aging! So what are your plans for the future?” This is hardly considered an appropriate way to start a conversation with somebody. We have been conditioned to resist and even take offense at references to our aging, associating it with diminishment, frailty, and dependence. It is far better, in this line of thinking, not to encourage reflection and planning but to opt for … Read more

  • Putting Primary Care First?

    May 31, 2019 | Christopher F. Koller, President

    With the release of its new primary care payment models last month, the Center for Medicare and Medicaid Innovation (CMMI) continues to act on the abundant evidence showing that a strong health care delivery system must be built on high-performing primary care. Whether these models will prove successful will depend in part on how much assistance primary care physicians need in efforts to … Read more

  • SIMulating Lessons in Aligning Health Care Payers

    Apr 18, 2019 | Christopher F. Koller, President

    The Affordable Care Act (ACA) was Christmas for health policy engineers—especially at the state level. With the stroke of the pen (and some divisive procedural maneuvering by Democrats), supporters of a strong state government role in health policy were handed a gift box of new tools—an individual mandate, an employer mandate for larger businesses, Medicaid coverage expansions, individual … Read more

  • “Deep and Abiding Relationships” – Rob Restuccia’s Legacy

    Mar 21, 2019 | Christopher F. Koller, President

    Advocates for change are not usually considered organization types. They staff the barriers, not the boardrooms, are seen as more comfortable with manifestos than meeting minutes, and often opt for confrontation instead of collaboration. Rob Restuccia was different, and that is only part of what made his passing on March 3, 2019, difficult for the many who respected and loved him. An advocate … Read more

  • Health Care Costs—Mapping the Forest and Finding a Path

    Feb 21, 2019 | Christopher F. Koller, President

    Health care costs comprise an expansive and poorly mapped forest. There are plenty of fearful features to the wilderness, including rising pharmaceutical costs, consolidating providers, multiplying administrators, aging populations, chronic diseases, and poor health behaviors. Different regions—Medicare, Medicaid, and private health insurance—evoke different and conflicting concerns and … Read more

  • “Deaths of Despair” – Prevention for a Growing Crisis

    Jan 28, 2019 | Christopher F. Koller, President

    I teach a public health course on the US health system. As the grizzled realist in the room, I remind my bright-eyed “public healthers” that being right is not the same as being effective. That while an ounce of prevention really is worth a pound of cure, it is not enough to hector the rest of us constantly. And that to make prevention efforts work, they have to understand where all the money … Read more

  • To Work and To Love—Health in Theory and Practice

    Dec 17, 2018 | Christopher F. Koller, President

    Sigmund Freud said, “Love and work are the cornerstones of our humanness.” That insight—that productive labor and positive human relationships improve one’s physical and mental health—is part of the increased interest in health care’s role in addressing the social determinants of health. The absence of these factors—such as economic stability, safe neighborhoods, access to education … Read more

  • Dear Governor – About Those Statements on Health Care Affordability

    Nov 27, 2018 | Christopher F. Koller, President

    Dear Newly-elected Governor: Congratulations on your victory on November 6th and for assembling successful campaign messages that resonated with so many in your state. Now about those statements on health care affordability. You are one of 19 new governors this year and I hope you and your colleagues did not overcommit yourselves on health care when you were out on the campaign trail. In … Read more

  • Maine’s Family Caregiving Referendum—Revolt of the Sandwiched?

    Oct 30, 2018 | Christopher F. Koller, President

    The “sandwich generation” refers to folks who look after both older family members and their own kids. These people—often in their 40s and 50s—are simultaneously coordinating the logistics and drama of both high school and home care. In Maine, a ballot referendum this fall to make home care more available to residents could give caregivers there a shot at relief, if enough others share … Read more

  • Provider Payment Reform: Right Course, Wrong Students?

    Sep 24, 2018 | Christopher F. Koller, President

    For the last eight years, the US health care system, led by Medicare, has been going to school, learning how to do comprehensive provider payment reform. The most important courses have focused on how to improve performance for entire populations of people. Efforts to promote accountable care organizations (ACOs) in particular have attempted to use payment changes to establish a seismic shift in … Read more