#JACR transcript · Thu Oct 23 9:16:32 PDT 2014 ruthcarlosmd RT @nxtstop1: @LLALO T1 Takes a long view~ it may be 10 yrs of financial loss before gain benefits of better care coordination.Orgs

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 1/24

#JACR transcript

Healthcare Social Media Transcript

From: Thu Oct 23 9:00:00 PDT 2014To: Thu Oct 23 10:15:00 PDT 2014

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llalo #JACR Looking forward to a great discussion. Thu Oct 23 9:00:18 PDT 2014

laurenwallner RT @UM_IHPI: Join our director @jzayanian for a tweetchat at 12 ET on #Medicaid,#ACOs & more. Use #JACR - topics @ http://t.co/ifWmTim5ra … Thu Oct 23 9:00:31 PDT 2014

ruthcarlosmd Welcome to #JACR tchat on health policy and innovation. @jzayanian gues mod w/key insights on ACOs, Medicaid expansion as UMich #IPHI dir Thu Oct 23 9:01:36 PDT 2014

nxtstop1 RT @ruthcarlosmd: How can pts influence policy? @jzayanian talks opps today at12p ET #JACR tchat. http://t.co/xaDaG6sizV @cancergeek @lung… Thu Oct 23 9:02:14 PDT 2014

nxtstop1 RT @UM_IHPI: Join our director @jzayanian for a tweetchat at 12 ET on #Medicaid,#ACOs & more. Use #JACR - topics @ http://t.co/ifWmTim5ra … Thu Oct 23 9:02:22 PDT 2014

ruthcarlosmd Hi @LLALO, welcome early bird! gr8 discussion with @jzayanian on #policy and#innovation. pls introduce yourselves. #jacr Thu Oct 23 9:03:21 PDT 2014

pfanderson RT @ruthcarlosmd: 5, 4, 3, 2, 1 counting down to @jzayanian today at 12p ET#JACR tchat on status of Medicaid expansion. http://t.co/xaDaG6… Thu Oct 23 9:03:40 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 2/24

pfanderson RT @UM_IHPI: Join our director @jzayanian for a tweetchat at 12 ET on #Medicaid,#ACOs & more. Use #JACR - topics @ http://t.co/ifWmTim5ra … Thu Oct 23 9:03:47 PDT 2014

nxtstop1 hello Ruth, our guest and everyone, Bernadette Keefe MD joining from Chapel HillNC ~ delighted to be with you ~ #jacr Thu Oct 23 9:04:14 PDT 2014

pfanderson Really excited about the #JACR chat NOW on health policy. Very important! #hcsm#hcldr Thu Oct 23 9:04:20 PDT 2014

pfanderson RT @MattHawkinsMD: .@JACRJournal - Great topic for this week's #JACR tchat -Health Policy and #Innovation -- http://t.co/kJeGXDj8ld -- Thu… Thu Oct 23 9:04:32 PDT 2014

kristinahoque Hi All! I'm a radiology resident at USC- looking forward to today's chat! #JACR Thu Oct 23 9:04:40 PDT 2014

jzayanian Glad to be joining you Ruth from @UM_IHPI, my bio: http://t.co/ur3KmXznGX #jacr Thu Oct 23 9:04:50 PDT 2014

ruthcarlosmd @nxtstop1 good to see you again after last month's super tchat. #jacr Thu Oct 23 9:05:06 PDT 2014

consumermedical We provided guided patient support to help employees get the best care possible.Happy to be here! #jacr Thu Oct 23 9:05:40 PDT 2014

pfanderson Patricia from #UMich, Emerging Technologies Informationist for the health sciences,very interested in policy & innovation! #jacr Thu Oct 23 9:05:47 PDT 2014

consumermedical We are new to #JACR so hello @jzayanian @ruthcarlosmd! Thu Oct 23 9:06:07 PDT 2014

nxtstop1 @ruthcarlosmd Wonderful to be back with you, Ruth and the group~ radiology hasmuch to gain from engaging on #SoMe~ #jacr Thu Oct 23 9:06:16 PDT 2014

ruthcarlosmd Leading with T1: Lessons learned from CMS ACO experiment. Disappointing?#JACR Thu Oct 23 9:07:05 PDT 2014

jpkanne Glad to be joining from the University of Wisconsin #JACR Thu Oct 23 9:08:34 PDT 2014

ruthcarlosmd Ground rules...we assume your tweets are your own. please use T1, T2, T3 to helpus follow conversations. #JACR Thu Oct 23 9:08:37 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 3/24

jdimick1 RT @ruthcarlosmd: 5, 4, 3, 2, 1 counting down to @jzayanian today at 12p ET#JACR tchat on status of Medicaid expansion. http://t.co/xaDaG6… Thu Oct 23 9:08:49 PDT 2014

ruthcarlosmd T1: What lessons can we learn from the CMS ACO experiment in quality-basedpayment models? #JACR Thu Oct 23 9:08:51 PDT 2014

consumermedical RT @ruthcarlosmd: T1: What lessons can we learn from the CMS ACO experimentin quality-based payment models? #JACR Thu Oct 23 9:09:25 PDT 2014

ucradsafety RT @pfanderson: Really excited about the #JACR chat NOW on health policy. Veryimportant! #hcsm #hcldr Thu Oct 23 9:09:53 PDT 2014

llalo T1. Not disappointing. I don't expect shared savings to be a long term solution,rather a transitional learning phase. #JACR Thu Oct 23 9:10:13 PDT 2014

jzayanian T1: Early results have been mixed, though CMS Viewpoint on Pioneer ACO’s morefavorable @JAMA_current http://t.co/646b7bWgSA #jacr Thu Oct 23 9:10:14 PDT 2014

nxtstop1 T1 Think too early to judge~ ACOs are still being set up, re configured. Tough to getthe numbers right>great,affordable care~ Process #jacr Thu Oct 23 9:10:25 PDT 2014

jdimick1 RT @jzayanian: T1: Early results have been mixed, though CMS Viewpoint onPioneer ACO’s more favorable @JAMA_current http://t.co/646b7bWgSA… Thu Oct 23 9:10:39 PDT 2014

pfanderson RT @jzayanian: T1: Early results have been mixed, though CMS Viewpoint onPioneer ACO’s more favorable @JAMA_current http://t.co/646b7bWgSA… Thu Oct 23 9:10:47 PDT 2014

ucradsafety Rebecca and Radiology Outcomes team joining from UCSF, glad to be here! #JACRThu Oct 23 9:10:55 PDT 2014

grebeccahaines T1: Uneven results = lessons learned #JACR Thu Oct 23 9:11:38 PDT 2014

llalo T1. Focus on care coordination and care process improvement, not on financialmeasures. The financial stuff will follow. #JACR Thu Oct 23 9:11:43 PDT 2014

nulall @ruthcarlosmd Neuroradiology fellow from University of Colorado, trying to join in onthe tweetchat between studies #jacr Thu Oct 23 9:11:47 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 4/24

consumermedical RT @jzayanian: T1: Early results have been mixed, though CMS Viewpoint onPioneer ACO’s more favorable @JAMA_current http://t.co/646b7bWgSA… Thu Oct 23 9:11:51 PDT 2014

onceupona RT @UM_IHPI: Join our director @jzayanian for a tweetchat at 12 ET on #Medicaid,#ACOs & more. Use #JACR - topics @ http://t.co/ifWmTim5ra … Thu Oct 23 9:11:58 PDT 2014

pfanderson More on results/outcomes #ACO so far http://t.co/kjjU526Con |http://t.co/q3yVwLpWvS | http://t.co/R5CpGNvC5w | http://t.co/fFOOLL6AuH #jacr Thu Oct 23 9:12:19 PDT 2014

ucradsafety RT @LLALO: T1. Not disappointing. I don't expect shared savings to be a long termsolution, rather a transitional learning phase. #JACR Thu Oct 23 9:12:25 PDT 2014

consumermedical RT @LLALO: T1. Focus on care coordination and care process improvement, not onfinancial measures. The financial stuff will follow. #JACR Thu Oct 23 9:12:32 PDT 2014

nxtstop1 @LLALO T1 Takes a long view~ it may be 10 yrs of financial loss before gainbenefits of better care coordination.Orgs can't survive. #jacr Thu Oct 23 9:12:49 PDT 2014

pfanderson Makes sense results mixed at the beginning, and I actually find the general trend ofreduced costs/increased efficiency heartening #jacr Thu Oct 23 9:13:19 PDT 2014

nxtstop1 Refs MT @pfanderson #ACO so far http://t.co/vjw0rmjUjg | http://t.co/t50IaR4h4S |http://t.co/2Mi3vKdfpd | http://t.co/XrJQ6cILpc #jacr Thu Oct 23 9:13:31 PDT 2014

radiologyacr RT @jzayanian: T1: Early results have been mixed, though CMS Viewpoint onPioneer ACO’s more favorable @JAMA_current http://t.co/646b7bWgSA… Thu Oct 23 9:13:32 PDT 2014

radiologyacr RT @grebeccahaines: T1: Uneven results = lessons learned #JACR Thu Oct 23 9:13:56 PDT 2014

pfanderson Accountable Care Organization 2014 Program Analysis Quality PerformanceStandards ... http://t.co/BMr3j52tCB #jacr Thu Oct 23 9:14:09 PDT 2014

jzayanian T1: @UMhealthsystem had favorable spending trend from pre-ACO MedicarePhysician Group Practice Demo: http://t.co/YHcqdvUcKK #jacr Thu Oct 23 9:14:37 PDT 2014

nxtstop1 MT @jzayanian T1: @UMhealthsystem had favorable spending trend: pre-ACOMedicare Physician Group Practice Demo: http://t.co/w0ZUlDEM5C #jacr Thu Oct 23 9:15:05 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 5/24

ruthcarlosmd @pfanderson #jacr not all ACO participants reported quality information, even if costsavings would have resulted in cms payout. Thu Oct 23 9:15:13 PDT 2014

jacrjournal RT @LLALO: T1. Focus on care coordination and care process improvement, not onfinancial measures. The financial stuff will follow. #JACR Thu Oct 23 9:15:31 PDT 2014

roguerad When a metric becomes a target it ceases to be a good metric. Goodhardt's Law.http://t.co/eSpTOFvcmZ #jacr Thu Oct 23 9:15:32 PDT 2014

kristinahoque We need to define "success" in order to accurately judge. What does success/failuremean to you? #JACR Thu Oct 23 9:15:34 PDT 2014

pfanderson RT @jzayanian: T1: @UMhealthsystem had favorable spending trend from pre-ACOMedicare Physician Group Practice Demo: http://t.co/YHcqdvUcKK… Thu Oct 23 9:15:58 PDT 2014

ruthcarlosmd RT @jzayanian: T1: @UMhealthsystem had favorable spending trend from pre-ACOMedicare Physician Group Practice Demo: http://t.co/YHcqdvUcKK… Thu Oct 23 9:16:12 PDT 2014

jzayanian T1: More experience from @UMHealthSystem on #pophealth management:http://t.co/DSFXXbNeAH #jacr Thu Oct 23 9:16:32 PDT 2014

ruthcarlosmd RT @nxtstop1: @LLALO T1 Takes a long view~ it may be 10 yrs of financial lossbefore gain benefits of better care coordination.Orgs can't s… Thu Oct 23 9:16:35 PDT 2014

nxtstop1 Will look at this.RT @RogueRad When a metric becomes a target it ceases to be agood metric. Goodhardt's Law. http://t.co/kN3viZJgmT #jacr Thu Oct 23 9:16:53 PDT 2014

consumermedical RT @KristinaHoque: We need to define "success" in order to accurately judge. Whatdoes success/failure mean to you? #JACR Thu Oct 23 9:16:54 PDT 2014

gingerconcept1 RT @RogueRad: When a metric becomes a target it ceases to be a good metric.Goodhardt's Law. http://t.co/eSpTOFvcmZ #jacr Thu Oct 23 9:17:04 PDT 2014

pfanderson More on the #ACO quality measures http://t.co/gl69JcIs6E Detailed overviewhttp://t.co/rvDfgxPHuN #jacr Thu Oct 23 9:17:17 PDT 2014

djparris RT @jzayanian: T1: Early results have been mixed, though CMS Viewpoint onPioneer ACO’s more favorable @JAMA_current http://t.co/646b7bWgSA… Thu Oct 23 9:17:20 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 6/24

jdimick1 @jzayanian T1 Do we know what UM did to achieve those favorable results? #jacr Thu Oct 23 9:17:31 PDT 2014

djparris RT @LLALO: T1. Focus on care coordination and care process improvement, not onfinancial measures. The financial stuff will follow. #JACR Thu Oct 23 9:17:37 PDT 2014

consumermedical .@KristinaHoque Increased patient engagement would be included in the definitionof success from our perspective #JACR Thu Oct 23 9:17:39 PDT 2014

nxtstop1 Agree.Pt outcome,$$ or both RT @KristinaHoque We need to define "success" inorder to judge. What does success/failure mean to you? #JACR Thu Oct 23 9:17:39 PDT 2014

pfanderson RT @KristinaHoque: We need to define "success" in order to accurately judge. Whatdoes success/failure mean to you? #JACR Thu Oct 23 9:18:05 PDT 2014

nxtstop1 How judge this ?MT @ConsumerMedical .@KristinaHoque incr patient engagementwld b included in defini of success from our perspective #JACR Thu Oct 23 9:18:30 PDT 2014

roguerad In culture where doing right thing for right reason counts, and rationing worse than 4letter word beginning with F, MSSP is wishful #jacr Thu Oct 23 9:18:51 PDT 2014

jzayanian @RogueRad Interesting perspective, good measures likely have a half-life likeHEDIS measure for beta-blockers post-MI #jacr Thu Oct 23 9:19:03 PDT 2014

jacrjournal RT @RogueRad: When a metric becomes a target it ceases to be a good metric.Goodhardt's Law. http://t.co/eSpTOFvcmZ #jacr Thu Oct 23 9:19:14 PDT 2014

pfanderson @KristinaHoque Exactly! They are meaning outcomes in major conditions -diabetes, COPD, asthma, cardiac, etc. Start big, then focus? #jacr Thu Oct 23 9:19:20 PDT 2014

nxtstop1 Yeh..MT @RogueRad In culture>doing right thing for right reason counts& rationingworse than 4 letter word begin w/ F,MSSP is wishful #jacr Thu Oct 23 9:19:44 PDT 2014

pfanderson @KristinaHoque Exactly! They are tracking outcomes in major conditions - diabetes,COPD, asthma, cardiac, etc. Start big, then focus? #jacr Thu Oct 23 9:19:47 PDT 2014

jdimick1 @KristinaHoque T1 Success = Lower cost growth for covered population, withouterosion of clinical quality (and hopefully improvement) #jacr Thu Oct 23 9:20:08 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 7/24

pfanderson RT @jzayanian: @RogueRad Interesting perspective, good measures likely have ahalf-life like HEDIS measure for beta-blockers post-MI #jacr Thu Oct 23 9:20:13 PDT 2014

ruthcarlosmd Time for T2: Where do we stand on Medicaid expansion under the Affordable CareAct? #JACR Thu Oct 23 9:20:42 PDT 2014

nxtstop1 Long view,need patience.MT @pfanderson @KristinaHoque Tracking outcomes inmajor conditions - diabetes, COPD, asthma, cardiac, etc.... #jacr Thu Oct 23 9:20:57 PDT 2014

ruthcarlosmd RT @jzayanian: @RogueRad Interesting perspective, good measures likely have ahalf-life like HEDIS measure for beta-blockers post-MI #jacr Thu Oct 23 9:21:00 PDT 2014

pfanderson @ruthcarlosmd I noticed that. Wonder why? Because their numbers weren't good?#jacr Thu Oct 23 9:21:07 PDT 2014

kristinahoque @nxtstop1@pfanderson agree! There are so many metrics- and goals do not alwaysalign. keep priorities in line - patients first! #JACR Thu Oct 23 9:21:18 PDT 2014

nxtstop1 Best~MT @KristinaHoque @nxtstop1@pfanderson agree! Many metrics- and goalsdo not always align. keep priorities in line - patients #1 #JACR Thu Oct 23 9:21:55 PDT 2014

consumermedical RT @ruthcarlosmd: Time for T2: Where do we stand on Medicaid expansion underthe Affordable Care Act? #JACR Thu Oct 23 9:22:18 PDT 2014

ruthcarlosmd @pfanderson #jacr --so ACO quality data asymmetry potentially leads to overestimation of quality improvement relative to cost savings. T1 Thu Oct 23 9:22:21 PDT 2014

pfanderson @KristinaHoque @nxtstop1 And you can't track everything from the get go. Start w/low hanging fruit (as they've done), expand later. #jacr Thu Oct 23 9:22:35 PDT 2014

jzayanian .@jdimick1 T1 Most savings were among Medicare/caid dual eligibles, likely thrubetter coordinated care & fewer readmissions #jacr Thu Oct 23 9:22:36 PDT 2014

ruthcarlosmd @nxtstop1 @KristinaHoque metrics may be in conflict, re stakeholder --pt / system /cms T1 #jacr Thu Oct 23 9:23:06 PDT 2014

roguerad @jzayanian Good comparison. A metric has a sensitivity and specificity. When weoverdo it, we cheapen its specificity over time. #jacr Thu Oct 23 9:23:09 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 8/24

jpkanne T2: Major issue is variability by state - WI opted not to participate. Very political.Creates double standards. #JACR Thu Oct 23 9:23:13 PDT 2014

nxtstop1 MT @jzayanian .@jdimick1 T1 Most savings from Medicare/caid dual eligibles, likelythru better coordinated care & fewer readmissions #jacr Thu Oct 23 9:23:16 PDT 2014

roguerad RT @jzayanian: @RogueRad Interesting perspective, good measures likely have ahalf-life like HEDIS measure for beta-blockers post-MI #jacr Thu Oct 23 9:23:23 PDT 2014

pfanderson RT @jzayanian: .@jdimick1 T1 Most savings were among Medicare/caid dualeligibles, likely thru better coordinated care & fewer readmissions… Thu Oct 23 9:23:29 PDT 2014

ruthcarlosmd RT @jzayanian: .@jdimick1 T1 Most savings were among Medicare/caid dualeligibles, likely thru better coordinated care & fewer readmissions… Thu Oct 23 9:23:39 PDT 2014

pfanderson @jzayanian @jdimick1 That is EXCELLENT! Not just better outcomes, but for theright reasons! #jacr Thu Oct 23 9:23:57 PDT 2014

nxtstop1 MT @RogueRad @jzayanian Good comparison.A metric has a sensitivity andspecificity. When overdo it, cheapen its specificity over time. #jacr Thu Oct 23 9:24:03 PDT 2014

kristinahoque @ruthcarlosmd @nxtstop1 agree - that's why each of the involved parties needs tohave a seat at the discussion table #JACR Thu Oct 23 9:24:25 PDT 2014

jzayanian .@ruthcarlosmd T2 @kaiserfamfound Map of state Medicaid expansion decisions,8/28/14: http://t.co/Ync2xsvKMQ #jacr Thu Oct 23 9:24:29 PDT 2014

pfanderson @jpkanne That's intriguing. And explains many comments I've heard recently fromfriends in Wisconsin #jacr Thu Oct 23 9:24:40 PDT 2014

nxtstop1 View>>RT @jzayanian .@ruthcarlosmd T2 @kaiserfamfound Map of state Medicaidexpansion decisions, 8/28/14: http://t.co/Kn7coJNN2U #jacr Thu Oct 23 9:24:57 PDT 2014

pfanderson @ruthcarlosmd There are always weak points in data. Being AWARE of them iscritical. I appreciate this important context #jacr Thu Oct 23 9:25:27 PDT 2014

radiologyacr RT @jdimick1: @KristinaHoque T1 Success = Lower cost growth for coveredpopulation, without erosion of clinical quality (and hopefully impr… Thu Oct 23 9:25:28 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 9/24

ruthcarlosmd RT @pfanderson: @ruthcarlosmd There are always weak points in data. BeingAWARE of them is critical. I appreciate this important context #j… Thu Oct 23 9:25:46 PDT 2014

pfanderson RT @jzayanian: .@ruthcarlosmd T2 @kaiserfamfound Map of state Medicaidexpansion decisions, 8/28/14: http://t.co/Ync2xsvKMQ #jacr Thu Oct 23 9:25:47 PDT 2014

nxtstop1 @jzayanian @ruthcarlosmd @kaiserfamfound T2 The non united states of america~RED/BLUE divide. Health of nation bound up w/politics~ #jacr Thu Oct 23 9:25:59 PDT 2014

acoalliance RT @pfanderson: More on the #ACO quality measures http://t.co/gl69JcIs6EDetailed overview http://t.co/rvDfgxPHuN #jacr Thu Oct 23 9:26:24 PDT 2014

acoalliance RT @jzayanian: T1: More experience from @UMHealthSystem on #pophealthmanagement: http://t.co/DSFXXbNeAH #jacr Thu Oct 23 9:26:47 PDT 2014

pfanderson Looks like only half the states opted in for ACO project http://t.co/oqCmdcUdJt #jacrhttp://t.co/UojgwA06bf Thu Oct 23 9:27:15 PDT 2014

nxtstop1 @2healthguru #jacr Thu Oct 23 9:27:22 PDT 2014

pfanderson RT @nxtstop1: @jzayanian @ruthcarlosmd @kaiserfamfound T2 The non unitedstates of america~ RED/BLUE divide. Health of nation bound up w/p… Thu Oct 23 9:27:34 PDT 2014

nxtstop1 RT @pfanderson: Looks like only half the states opted in for ACO projecthttp://t.co/oqCmdcUdJt #jacr http://t.co/UojgwA06bf Thu Oct 23 9:27:55 PDT 2014

djparris RT @RogueRad: When a metric becomes a target it ceases to be a good metric.Goodhardt's Law. http://t.co/eSpTOFvcmZ #jacr Thu Oct 23 9:28:12 PDT 2014

acoalliance RT @pfanderson: Accountable Care Organization 2014 Program Analysis QualityPerformance Standards ... http://t.co/BMr3j52tCB #jacr Thu Oct 23 9:28:17 PDT 2014

eqhealth RT @LLALO: T1. Focus on care coordination and care process improvement, not onfinancial measures. The financial stuff will follow. #JACR Thu Oct 23 9:28:18 PDT 2014

aboutdunne RT @pfanderson: Looks like only half the states opted in for ACO projecthttp://t.co/oqCmdcUdJt #jacr http://t.co/UojgwA06bf Thu Oct 23 9:29:34 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 10/24

jzayanian T2 New paper today on early Michigan #Medicaid expansion @UM_IHPI @NEJMhttp://t.co/VjuBaifLbE Podcast: http://t.co/q6pcSS26tC #jacr Thu Oct 23 9:29:52 PDT 2014

acoalliance RT @jzayanian: .@ruthcarlosmd T2 @kaiserfamfound Map of state Medicaidexpansion decisions, 8/28/14: http://t.co/Ync2xsvKMQ #jacr Thu Oct 23 9:30:03 PDT 2014

ruthcarlosmd @jzayanian 1/2 of states expanded medicaid... prelim impact data? cc #JACR@pfanderson Thu Oct 23 9:30:17 PDT 2014

eqhealth Read this. "Crafting collaborative relationships with community-based caregivers toboost patient care is key." http://t.co/LIrsH4J36b #jacr Thu Oct 23 9:30:19 PDT 2014

acoalliance RT @pfanderson: Looks like only half the states opted in for ACO projecthttp://t.co/oqCmdcUdJt #jacr http://t.co/UojgwA06bf Thu Oct 23 9:30:21 PDT 2014

nxtstop1 @AboutDunne @pfanderson T2 Similar 2 map of medicaid expansion. all 4 similarreasons. Do we take care of each other or not? Red/Blue #jacr Thu Oct 23 9:30:37 PDT 2014

um_ihpi RT @jzayanian: T2 New paper today on early Michigan #Medicaid expansion@UM_IHPI @NEJM http://t.co/VjuBaifLbE Podcast: http://t.co/q6pcSS26… Thu Oct 23 9:30:43 PDT 2014

2healthguru @nxtstop1 got it. following #jacr via @acoalliance Thu Oct 23 9:30:47 PDT 2014

pfanderson RT @nxtstop1: @AboutDunne @pfanderson T2 Similar 2 map of medicaidexpansion. all 4 similar reasons. Do we take care of each other or not? … Thu Oct 23 9:30:50 PDT 2014

drgmcginty sorry to be late #jacr, great discussion #ACO Thu Oct 23 9:30:54 PDT 2014

pfanderson RT @jzayanian: T2 New paper today on early Michigan #Medicaid expansion@UM_IHPI @NEJM http://t.co/VjuBaifLbE Podcast: http://t.co/q6pcSS26… Thu Oct 23 9:31:04 PDT 2014

pfanderson @jzayanian @UM_IHPI @NEJM Congratulations! Excellent contribution to the#ACO literature #jacr Thu Oct 23 9:31:42 PDT 2014

jzayanian .@pfanderson T2 state politics of #Medicaid expansion are complex @UM_IHPI@JAMA_current http://t.co/p6VfzwyUKo #jacr Thu Oct 23 9:31:48 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 11/24

jacrjournal RT @jpkanne: T2: Major issue is variability by state - WI opted not to participate.Very political. Creates double standards. #JACR Thu Oct 23 9:32:08 PDT 2014

nxtstop1 Refs thxRT @jzayanian .@pfanderson T2 state politics of #Medicaid expansion arecomplex @UM_IHPI @JAMA_current http://t.co/L5HXShMUam #jacr Thu Oct 23 9:32:16 PDT 2014

jacrjournal RT @RogueRad: @jzayanian Good comparison. A metric has a sensitivity andspecificity. When we overdo it, we cheapen its specificity over ti… Thu Oct 23 9:32:17 PDT 2014

roguerad Value like economics & politics is local. We kill 50 % of it by defining it. We kill 50 %of what remains by defining it again. #jacr Thu Oct 23 9:32:44 PDT 2014

pfanderson NEJM: Launching the Healthy Michigan Plan — The First 100 Dayshttp://t.co/wBNmfL989Y #jacr by @jzayanian Thu Oct 23 9:32:53 PDT 2014

pfanderson RT @jzayanian: .@pfanderson T2 state politics of #Medicaid expansion are complex@UM_IHPI @JAMA_current http://t.co/p6VfzwyUKo #jacr Thu Oct 23 9:33:09 PDT 2014

ucradsafety RT @nxtstop1: @jzayanian @ruthcarlosmd @kaiserfamfound T2 The non unitedstates of america~ RED/BLUE divide. Health of nation bound up w/p… Thu Oct 23 9:33:11 PDT 2014

nxtstop1 Thanks for that !RT @pfanderson NEJM: Launching the Healthy Michigan Plan —The First 100 Days http://t.co/sbeFp7mZ2S #jacr by @jzayanian Thu Oct 23 9:33:17 PDT 2014

pfanderson @jzayanian @UM_IHPI @JAMA_current Love this line: "State flexibility is a double-edged sword" http://t.co/tAz9BCxWvb #jacr Thu Oct 23 9:33:57 PDT 2014

kristinahoque RT @pfanderson: NEJM: Launching the Healthy Michigan Plan — The First 100Days http://t.co/wBNmfL989Y #jacr by @jzayanian Thu Oct 23 9:34:09 PDT 2014

pfanderson @nxtstop1 @jzayanian He posted it first. I just added the title. :) #jacr Thu Oct 23 9:34:27 PDT 2014

nxtstop1 RT @pfanderson @jzayanian @UM_IHPI @JAMA_current Love this line: "Stateflexibility is a double-edged sword" http://t.co/h4NnTCbhTd #jacr Thu Oct 23 9:34:50 PDT 2014

ruthcarlosmd RT @pfanderson: @jzayanian @UM_IHPI @JAMA_current Love this line: "Stateflexibility is a double-edged sword" http://t.co/tAz9BCxWvb #jacr Thu Oct 23 9:34:58 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 12/24

roguerad RT @ruthcarlosmd: @nxtstop1 @KristinaHoque metrics may be in conflict, restakeholder --pt / system / cms T1 #jacr Thu Oct 23 9:35:23 PDT 2014

jzayanian .@ruthcarlosmd T2 strong evidence of #Medicaid enrollment surge for low-incomeadults, but impact on access and outcomes TBD #jacr Thu Oct 23 9:35:35 PDT 2014

2healthguru ACOs are a state of mind, bound together by culture of collaboration & teamwork.Not an ‘organization’. We have a long way to go! #jacr Thu Oct 23 9:35:42 PDT 2014

pfanderson @ruthcarlosmd @nxtstop1 Curious! Is this just in elderly? Earlier research showedengagement of family impt in this understanding #jacr Thu Oct 23 9:36:04 PDT 2014

2healthguru If you’ve seen one [ACO or derivative play] you’ve seen one. #jacr Thu Oct 23 9:36:22 PDT 2014

nxtstop1 @jzayanian @ruthcarlosmd T2 Right, so many r receiving care late in theirdisease.Think we'll need a generation to know~ #jacr Thu Oct 23 9:36:29 PDT 2014

pfanderson RT @2healthguru: ACOs are a state of mind, bound together by culture ofcollaboration & teamwork. Not an ‘organization’. We have a long way… Thu Oct 23 9:36:45 PDT 2014

roguerad @ruthcarlosmd @nxtstop1 @KristinaHoque You can say that again! How aboutindividual and population? #jacr Thu Oct 23 9:36:50 PDT 2014

nxtstop1 Agree MT @2healthguru ACOs= state of mind,bound by culture of collaboration &teamwork. Not ‘organization’.We have long way to go! #jacr Thu Oct 23 9:37:29 PDT 2014

joebabaian RT @pfanderson: Really excited about the #JACR chat NOW on health policy. Veryimportant! #hcsm #hcldr Thu Oct 23 9:37:46 PDT 2014

ruthcarlosmd TMI (test morbidity index)--the new index for imaging test discomfort via healthimaging http://t.co/qyaLW1gelp #JACR Thu Oct 23 9:37:47 PDT 2014

pfanderson Women’s Health and the Affordable Care Act: High Hopes Versus Harsh Realities?http://t.co/4bWfP2PqZm via @ruthcarlosmd #jacr Thu Oct 23 9:37:50 PDT 2014

pfanderson RT @nxtstop1: @jzayanian @ruthcarlosmd T2 Right, so many r receiving care latein their disease.Think we'll need a generation to know~ #jacr Thu Oct 23 9:38:27 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 13/24

the_cgordon RT @pfanderson: Women’s Health and the Affordable Care Act: High Hopes VersusHarsh Realities? http://t.co/4bWfP2PqZm via @ruthcarlosmd #ja… Thu Oct 23 9:38:42 PDT 2014

jdimick1 RT @2healthguru: If you’ve seen one [ACO or derivative play] you’ve seen one.#jacr Thu Oct 23 9:38:51 PDT 2014

kristinahoque RT @ruthcarlosmd: TMI (test morbidity index)--the new index for imaging testdiscomfort via health imaging http://t.co/qyaLW1gelp #JACR Thu Oct 23 9:38:52 PDT 2014

pfanderson @nxtstop1 @jzayanian @ruthcarlosmd YES! Need a generation to build a culturearound awareness & engagement #s4pm #jacr Thu Oct 23 9:38:53 PDT 2014

nxtstop1 Idiosyncratic re MDs,pts,location,goals,affiliations RT @2healthguru If you’ve seenone [ACO or derivative play] you’ve seen one. #jacr Thu Oct 23 9:39:08 PDT 2014

nxtstop1 Like RT @KristinaHoque RT @ruthcarlosmd: TMI (test morbidity index)--the newindex for imaging test discomfort http://t.co/9D6er6xdBa #JACR Thu Oct 23 9:39:41 PDT 2014

pfanderson RT @nxtstop1: Idiosyncratic re MDs,pts,location,goals,affiliations RT @2healthguruIf you’ve seen one [ACO or derivative play] you’ve seen … Thu Oct 23 9:39:44 PDT 2014

pfanderson @nxtstop1 @2healthguru So what do they actually have in common? #aco #jacr Thu Oct 23 9:40:10 PDT 2014

jdimick1 RT @jzayanian: New paper today on early Michigan #Medicaid expansion@UM_IHPI http://t.co/wWOQ0hj8o7 Podcast: http://t.co/doT0hFNA4b #jacr” Thu Oct 23 9:40:17 PDT 2014

nxtstop1 Hi Joe, yes,welcome! ~ RT @JoeBabaian RT @pfanderson: Really excited aboutthe #JACR chat NOW on health policy. Very important! #hcsm #hcldr Thu Oct 23 9:40:20 PDT 2014

pfanderson RT @nxtstop1: Like RT @KristinaHoque RT @ruthcarlosmd: TMI (test morbidityindex)--the new index for imaging test discomfort http://t.co/9D… Thu Oct 23 9:40:22 PDT 2014

altarum_cshs RT @jzayanian: .@ruthcarlosmd T2 strong evidence of #Medicaid enrollment surgefor low-income adults, but impact on access and outcomes TBD… Thu Oct 23 9:40:27 PDT 2014

ruthcarlosmd Time for T3: How can providers and patients help develop better evidence to guideimaging care policy? #JACR Thu Oct 23 9:40:34 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 14/24

eqhealth Support being #1. MT @bsquareds Whether #Medicare provider collabs/#ACOssucceed dependent on deal structure, monitoring, and support. #jacr Thu Oct 23 9:41:00 PDT 2014

pfanderson Comparing Morbidities of Testing With a New Index: Screening Colonoscopy VersusCore-Needle Breast Biopsy http://t.co/PT6Myx8hTY #jacr Thu Oct 23 9:41:09 PDT 2014

ucradsafety RT @2healthguru: ACOs are a state of mind, bound together by culture ofcollaboration & teamwork. Not an ‘organization’. We have a long way… Thu Oct 23 9:41:19 PDT 2014

pfanderson RT @ruthcarlosmd: Time for T3: How can providers and patients help develop betterevidence to guide imaging care policy? #JACR Thu Oct 23 9:41:30 PDT 2014

jaffri RT @jdimick1: RT @jzayanian: New paper today on early Michigan #Medicaidexpansion @UM_IHPI http://t.co/wWOQ0hj8o7 Podcast: http://t.co/do… Thu Oct 23 9:41:31 PDT 2014

2healthguru @pfanderson @nxtstop1 philosophical/operational shift (touchstones totransformation) from volume to value. A grand canyon leap, imj. #jacr Thu Oct 23 9:41:59 PDT 2014

ucradsafety RT @ruthcarlosmd: Time for T3: How can providers and patients help develop betterevidence to guide imaging care policy? #JACR Thu Oct 23 9:42:21 PDT 2014

nxtstop1 My concept: Set up for integrated care,hope better outcome,decr $$ RT@pfanderson @2healthguru So what do they have in common? #aco #jacr Thu Oct 23 9:42:21 PDT 2014

jzayanian T2 important 2 note #Medicaid is largest insurer in US @kaiserfamfound & covers 1in 5 Americans (66M): http://t.co/8sdcoEQYXc #jacr Thu Oct 23 9:42:24 PDT 2014

ruthcarlosmd T3: empower pts to request quality data to be made public from own institution andothers. #JACR Thu Oct 23 9:42:24 PDT 2014

consumermedical RT @ruthcarlosmd: Time for T3: How can providers and patients help develop betterevidence to guide imaging care policy? #JACR Thu Oct 23 9:42:29 PDT 2014

pfanderson @ruthcarlosmd I love idea of test morbidity index (TMI), perhaps general use, builddata on adverse events/outcomes & what works? #jacr Thu Oct 23 9:42:35 PDT 2014

pfanderson RT @2healthguru: @pfanderson @nxtstop1 philosophical/operational shift(touchstones to transformation) from volume to value. A grand canyon… Thu Oct 23 9:42:47 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 15/24

jpkanne Decision support software is a good start. Providing ordering MDs with feedback andcomparison to peers might influence behavior #JACR Thu Oct 23 9:42:53 PDT 2014

askappdev RT @jdimick1: RT @jzayanian: New paper today on early Michigan #Medicaidexpansion @UM_IHPI http://t.co/wWOQ0hj8o7 Podcast: http://t.co/do… Thu Oct 23 9:42:53 PDT 2014

nxtstop1 MT @2healthguru @pfanderson @nxtstop1 philosophical/operational shift fomvolume to value.A grand canyon leap, imj. #jacr Thu Oct 23 9:43:20 PDT 2014

pfanderson @2healthguru @nxtstop1 So ACOs give a framework on which to build atransformational culture shift? #jacr Thu Oct 23 9:43:25 PDT 2014

2healthguru @jzayanian @kaiserfamfound yes, and isn’t that just amazing! ' #Medicaid is largestinsurer in US’ Talk about structural shifts! #jacr Thu Oct 23 9:43:29 PDT 2014

pfanderson RT @jzayanian: T2 important 2 note #Medicaid is largest insurer in US@kaiserfamfound & covers 1 in 5 Americans (66M): http://t.co/8sdcoEQY… Thu Oct 23 9:43:36 PDT 2014

ucradsafety T3: Lots of great evidence-based research in imaging out there, time to put itregularly into practice. Decision support tools. #JACR Thu Oct 23 9:43:44 PDT 2014

pfanderson RT @ruthcarlosmd: T3: empower pts to request quality data to be made public fromown institution and others. #JACR Thu Oct 23 9:43:48 PDT 2014

kristinahoque RT @ruthcarlosmd: T3: empower pts to request quality data to be made public fromown institution and others. #JACR Thu Oct 23 9:43:53 PDT 2014

kristinahoque RT @jpkanne: Decision support software is a good start. Providing ordering MDswith feedback and comparison to peers might influence behav… Thu Oct 23 9:44:03 PDT 2014

healthfoodpage1 RT @pfanderson: Comparing Morbidities of Testing With a New Index: ScreeningColonoscopy Versus Core-Needle Breast Biopsy http://t.co/PT6My… Thu Oct 23 9:44:06 PDT 2014

angleawojtczak RT @pfanderson: Comparing Morbidities of Testing With a New Index: ScreeningColonoscopy Versus Core-Needle Breast Biopsy http://t.co/PT6My… Thu Oct 23 9:44:07 PDT 2014

2healthguru +1 RT @pfanderson: @2healthguru @nxtstop1 So ACOs give a framework onwhich to build a transformational culture shift? #jacr Thu Oct 23 9:44:24 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 16/24

kristinahoque @jpkanne love this! Could be very effective #JACR Thu Oct 23 9:44:28 PDT 2014

consumermedical .@ruthcarlosmd Yes! Patients need help & education knowing the right questions toask. #JACR Thu Oct 23 9:44:45 PDT 2014

jbbc “@ruthcarlosmd: How can pts influence policy? @jzayanian talks opps today at 12pET #JACR tchat. http://t.co/bxC2GM8lIK Thu Oct 23 9:44:50 PDT 2014

jzayanian .@ruthcarlosmd @UM_IHPI T3 shout out to you, Ruth, for your JACR article on@PCORI imaging research: http://t.co/YmYLY7wBjQ #jacr Thu Oct 23 9:45:11 PDT 2014

nxtstop1 Info 4 all~learn MT @pfanderson @ruthcarlosmd love idea of test morbidity index(TMI),build data>adverse events/outcomes &what works? #jacr Thu Oct 23 9:45:16 PDT 2014

pfanderson @ruthcarlosmd @eaonc TMI impacts on compliance, acceptance of results, couldsave lives #jacr Thu Oct 23 9:45:34 PDT 2014

consumermedical T3: Educating patients & providing them with the evidence-based research onimaging is important. Empower informed decisions #JACR Thu Oct 23 9:45:35 PDT 2014

nxtstop1 MT @jzayanian .@ruthcarlosmd @UM_IHPI T3 shout out 2 u, Ruth, 4 yr JACRarticle on @PCORI imaging research: http://t.co/AyfTwCb1X1 #jacr Thu Oct 23 9:45:47 PDT 2014

kristinahoque RT @jzayanian: .@ruthcarlosmd @UM_IHPI T3 shout out to you, Ruth, for yourJACR article on @PCORI imaging research: http://t.co/YmYLY7wBjQ… Thu Oct 23 9:46:07 PDT 2014

2healthguru @pfanderson @nxtstop1 unfortunately for some w/ quarterly earnings per sharehorizon, not much ‘tolerance’ for short term ‘failures’ #jacr Thu Oct 23 9:46:08 PDT 2014

pfanderson RT @UCRadSafety: T3: Lots of great evidence-based research in imaging out there,time to put it regularly into practice. Decision support t… Thu Oct 23 9:46:11 PDT 2014

ucradsafety T3: Develop more robust appropriateness criteria for imaging studies. #JACR Thu Oct 23 9:46:33 PDT 2014

jbbc “@ruthcarlosmd: T3: empower pts to request quality data to be made public fromown institution and others. #JACR Thu Oct 23 9:46:41 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 17/24

pfanderson @UCRadSafety Evidence based data/guides essential, but retroactive. Also needproactive responsive tools #jacr Thu Oct 23 9:46:57 PDT 2014

ruthcarlosmd @jpkanne imits to decision supp when clinicians/peers(!) dont buy into evidence.limits peer pressure. name-n-shame can backfire. #JACR Thu Oct 23 9:47:00 PDT 2014

pfanderson RT @ConsumerMedical: .@ruthcarlosmd Yes! Patients need help & educationknowing the right questions to ask. #JACR Thu Oct 23 9:47:04 PDT 2014

nxtstop1 Also show how quality studies save $$ (no repeats)RT @UCRadSafety T3:Developmore robust appropriateness criteria for imaging studies. #JACR Thu Oct 23 9:47:38 PDT 2014

2healthguru @CMSGov & @CMSinnovates have it right. A minimum 3 year crosswalk to forgeculture and shape operations, imj. Yet, witness CEO 1/2 #jacr Thu Oct 23 9:47:39 PDT 2014

pfanderson @ConsumerMedical @ruthcarlosmd I want to see a patient guide/video for EVERYspecialty: Best 10 questions to ask your _____. #jacr Thu Oct 23 9:47:43 PDT 2014

jzayanian RT @UCRadSafety: T3: Develop more robust appropriateness criteria for imagingstudies. #JACR Thu Oct 23 9:48:03 PDT 2014

pfanderson RT @ruthcarlosmd: @jpkanne imits to decision supp when clinicians/peers(!) dontbuy into evidence. limits peer pressure. name-n-shame can b… Thu Oct 23 9:48:13 PDT 2014

nxtstop1 Like RT @pfanderson @ConsumerMedical @ruthcarlosmd A patient guide/video forEVERY specialty: Best 10 questions to ask your _____. #jacr Thu Oct 23 9:48:23 PDT 2014

pfanderson @ruthcarlosmd @jpkanne I've been hearing this a lot in psych. "Don't tell me what'sbest for MY patient!" #jacr Thu Oct 23 9:48:41 PDT 2014

roguerad .@ruthcarlosmd Ask policymakers what Cheshire Cat asked Alice. 'where do youwant to go ( in terms of $)?' #jacr Thu Oct 23 9:48:42 PDT 2014

2healthguru 2/2 Samitt at @helloHCP (@DaVita). Could wait for blended transition from volumeto value. Also United American retrenchment. #jacr Thu Oct 23 9:48:59 PDT 2014

pfanderson @2healthguru @nxtstop1 Which means that is the wrong measure to be using, but... #jacr Thu Oct 23 9:49:24 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 18/24

consumermedical @nxtstop1 @pfanderson @ruthcarlosmd That's BIG part of the service we provide,actually. Pre-made + customized question sets #JACR Thu Oct 23 9:50:09 PDT 2014

pfanderson @ConsumerMedical @ruthcarlosmd I try to include this when I design patientresources. Esp. for Dx w/ many specialist referrals #jacr Thu Oct 23 9:50:14 PDT 2014

ucradsafety T3: More value needs to be placed on evidence-based medicine than on maintainingthe status quo. Denial of evidence is a concern. #JACR Thu Oct 23 9:50:16 PDT 2014

ruthcarlosmd @pfanderson @consumermedical #JACR youtube channel devel 4 imaging. want tohear from pts re own experiences. bidirectional ed opp... Thu Oct 23 9:50:18 PDT 2014

pfanderson RT @ruthcarlosmd: @pfanderson @consumermedical #JACR youtube channeldevel 4 imaging. want to hear from pts re own experiences. bidirecti… Thu Oct 23 9:50:43 PDT 2014

2healthguru @pfanderson @nxtstop1 agree! because we need to redefine ‘failure’ as learningopportunities to shape efforts going forward. #jacr Thu Oct 23 9:51:16 PDT 2014

pfanderson @ruthcarlosmd @ConsumerMedical Yes! This was one of the ideas I hoped wouldappear in it. What to ask your radiologist? How/when also #jacr Thu Oct 23 9:51:16 PDT 2014

ruthcarlosmd @RogueRad OR...just convert Medicare/ Medicaid into consumer driven healthplans...vote with $$ #JACR T3 Thu Oct 23 9:51:21 PDT 2014

nxtstop1 Gr8 news! MT @ruthcarlosmd @pfanderson @consumermedical #JACR youtubechannel devel 4 imaging,want to hear: pts re own exp bidir edu opp... Thu Oct 23 9:52:10 PDT 2014

consumermedical RT @pfanderson: @ruthcarlosmd @ConsumerMedical Yes! This was one of theideas I hoped would appear in it. What to ask your radiologist? How… Thu Oct 23 9:52:14 PDT 2014

jzayanian T3 ICYMI @theIOM top 100 priorities for comparativeness effectiveness researchhttp://t.co/c7pYCEiyaj, incl 9 for imaging #jacr Thu Oct 23 9:52:23 PDT 2014

jpkanne @ruthcarlosmd @pfanderson One of the hardest challenges in medicine QI isstandardization in delivery care, need to go past anectdote #JACR Thu Oct 23 9:52:28 PDT 2014

pfanderson @UCRadSafety Evidence-based medicine is a baseline. Need to define that

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 19/24

baseline, but also hv guides for integrating clinical judgment #jacr Thu Oct 23 9:52:32 PDT 2014

roguerad .@DrGMcGinty @ruthcarlosmd To me seems like Mad Hatter's party, whereeveryone talking over other & wizardry with conditional probs #jacr Thu Oct 23 9:52:47 PDT 2014

nxtstop1 RT @jzayanian: T3 ICYMI @theIOM top 100 priorities for comparativenesseffectiveness research http://t.co/c7pYCEiyaj, incl 9 for imaging #j… Thu Oct 23 9:52:51 PDT 2014

pfanderson RT @2healthguru: @pfanderson @nxtstop1 agree! because we need to redefine‘failure’ as learning opportunities to shape efforts going forwar… Thu Oct 23 9:52:54 PDT 2014

roguerad RT @ruthcarlosmd: @RogueRad OR...just convert Medicare/ Medicaid intoconsumer driven health plans...vote with $$ #JACR T3 Thu Oct 23 9:52:56 PDT 2014

llalo T3. High deductible plans are going to drive pt behavior & demands, as pts spendtheir own $ will want cost, quality and service info #jacr Thu Oct 23 9:53:31 PDT 2014

ucradsafety @jpkanne Something similar worked within the UC Hospitals. Comparing data madeRads much more open to changing practice. #JACR T3 Thu Oct 23 9:53:36 PDT 2014

pfanderson @2healthguru @nxtstop1 "Blame" is wrong response. Just spent week w/ dad innursing home. Heard lots of patient blaming language #jacr Thu Oct 23 9:53:47 PDT 2014

roguerad .@ruthcarlosmd The problem with your suggestion is that there's a risk it might work.We wouldn't want that in healthcare. #jacr Thu Oct 23 9:53:58 PDT 2014

2healthguru @pfanderson @UCRadSafety agree! See: ‘Why Doctors Need Stories’ Narrativematters! http://t.co/MCLUEJIi3f #jacr Thu Oct 23 9:54:02 PDT 2014

elinsilveous “@jzayanian: T3 ICYMI @theIOM top100 priorities for comparativenesseffectiveness research http://t.co/SNWURuufkX, incl 9 for imaging #jacr” Thu Oct 23 9:54:21 PDT 2014

pfanderson @2healthguru @nxtstop1 Patient blaming, nurse blaming. Real problem wasn'teither - was org architecture, understaffing. #hcldr #jacr Thu Oct 23 9:54:28 PDT 2014

ucradsafety RT @pfanderson: @UCRadSafety Evidence-based medicine is a baseline. Need todefine that baseline, but also hv guides for integrating clinic… Thu Oct 23 9:54:40 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 20/24

pfanderson RT @jpkanne: @ruthcarlosmd @pfanderson One of the hardest challenges inmedicine QI is standardization in delivery care, need to go past an… Thu Oct 23 9:54:45 PDT 2014

nxtstop1 @jpkanne @ruthcarlosmd @pfanderson You are not kidding!Against independentpractice grain.Argument 4>US HC too expensive,bad outcomes #jacr Thu Oct 23 9:54:55 PDT 2014

ruthcarlosmd @RogueRad @DrGMcGinty magic mushroom does not work to increase resourcesdecrease systme burden. #JACR Thu Oct 23 9:54:57 PDT 2014

2healthguru +1 RT @pfanderson: @nxtstop1 Patient blaming, nurse blaming. Real problemwasn't either - was org architecture, understaffing. #hcldr #jacr Thu Oct 23 9:54:58 PDT 2014

pfanderson @jpkanne @ruthcarlosmd Need both data & anecdote. Need to select anecdotes tomatch/expand the data #jacr Thu Oct 23 9:55:11 PDT 2014

pfanderson RT @2healthguru: @pfanderson @UCRadSafety agree! See: ‘Why Doctors NeedStories’ Narrative matters! http://t.co/MCLUEJIi3f #jacr Thu Oct 23 9:55:21 PDT 2014

pfanderson @2healthguru @UCRadSafety I saw that! Excited to read it. #jacr Thu Oct 23 9:55:38 PDT 2014

ruthcarlosmd Closing thoughts? Future directions? #JACR Thu Oct 23 9:55:42 PDT 2014

2healthguru I love your twitter handle! >> @RogueRad #jacr Thu Oct 23 9:56:00 PDT 2014

pfanderson RT @UCRadSafety: @jpkanne Something similar worked within the UC Hospitals.Comparing data made Rads much more open to changing practice. #… Thu Oct 23 9:56:11 PDT 2014

meghanakeshavan RT @pfanderson: Looks like only half the states opted in for ACO projecthttp://t.co/oqCmdcUdJt #jacr http://t.co/UojgwA06bf Thu Oct 23 9:56:29 PDT 2014

pfanderson @UCRadSafety @jpkanne "anecdotes amuse, data persuades" But stories connectthem. #jacr Thu Oct 23 9:56:43 PDT 2014

nxtstop1 Pt story:core o'care MT @2healthguru @pfanderson @UCRadSafety Why DoctorsNeed Stories’ Narrative matters! http://t.co/tFkMcKo6AT #jacr Thu Oct 23 9:57:01 PDT 2014

2healthguru @ruthcarlosmd no way but forward. Biz as usual not longer an option in unread

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 21/24

‘strategic plans’…. Get busy, fail fast, keep learning! #jacr Thu Oct 23 9:57:28 PDT 2014

consumermedical Special thanks to @ruthcarlosmd @jzayanian @JACRJournal for hosting today'schat. Lots of great information shared. #jacr Thu Oct 23 9:57:47 PDT 2014

2healthguru @ruthcarlosmd no way but forward. Biz as usual no longer an option in unread‘strategic plans’…. Get busy, fail fast, keep learning! #jacr Thu Oct 23 9:57:49 PDT 2014

pfanderson @RogueRad @ruthcarlosmd Oh? What abt informed consent? Don't shove doc'schosen Tx down patient's throat. Pt has rt to choose "badly" #jacr Thu Oct 23 9:57:56 PDT 2014

roguerad .@ruthcarlosmd Be descriptive, may be prescriptive but not normative. Or, in termsof Hume's Guillotine, imaging is, not ought to be. #jacr Thu Oct 23 9:58:13 PDT 2014

llalo #jacr Shared savings is a transitional period on road to risk based models, ultimatelycapitation. ACOs need to learn & structure for future Thu Oct 23 9:58:18 PDT 2014

jzayanian .@ruthcarlosmd T3 is @ACR implementing #choosingwisely recs?http://t.co/3HPJqf3fXd #jacr Thu Oct 23 9:58:22 PDT 2014

pfanderson RT @ConsumerMedical: Special thanks to @ruthcarlosmd @jzayanian@JACRJournal for hosting today's chat. Lots of great information shared. #j… Thu Oct 23 9:58:43 PDT 2014

kristinahoque Fantastic to hear so many prospectives! Thanks everyone for a wonderful chat!#JACR Thu Oct 23 9:58:48 PDT 2014

pfanderson RT @2healthguru: @ruthcarlosmd no way but forward. Biz as usual no longer anoption in unread ‘strategic plans’…. Get busy, fail fast, keep… Thu Oct 23 9:58:50 PDT 2014

nxtstop1 RT @jzayanian: .@ruthcarlosmd T3 is @ACR implementing #choosingwisely recs?http://t.co/3HPJqf3fXd #jacr Thu Oct 23 9:59:00 PDT 2014

pfanderson @2healthguru @ruthcarlosmd Yes, design org structures to support rapidinnovation, flexible response. #jacr Thu Oct 23 9:59:16 PDT 2014

eqhealth RT @nxtstop1: Pt story:core o'care MT @2healthguru @pfanderson@UCRadSafety Why Doctors Need Stories’ Narrative matters! http://t.co/tFkMc… Thu Oct 23 9:59:34 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 22/24

indyhiguera RT @nxtstop1: @jpkanne @ruthcarlosmd @pfanderson You are not kidding!Againstindependent practice grain.Argument 4>US HC too expensive,bad … Thu Oct 23 9:59:37 PDT 2014

pfanderson RT @nxtstop1: Pt story:core o'care MT @2healthguru @pfanderson@UCRadSafety Why Doctors Need Stories’ Narrative matters! http://t.co/tFkMc… Thu Oct 23 9:59:58 PDT 2014

ruthcarlosmd @pfanderson @RogueRad An informed "no" should count as much as a "yes" eg inscreening or vaccination. #JACR Thu Oct 23 10:00:08 PDT 2014

jzayanian Thanks to @ruthcarlosmd & @jacr for hosting lively policy tweet chat! #jacr Thu Oct 23 10:00:16 PDT 2014

pfanderson RT @ruthcarlosmd: @pfanderson @RogueRad An informed "no" should count asmuch as a "yes" eg in screening or vaccination. #JACR Thu Oct 23 10:00:40 PDT 2014

nxtstop1 Thanks for being such a super host for us ~ RT @jzayanian Thanks to@ruthcarlosmd & @jacr for hosting lively policy tweet chat! #jacr Thu Oct 23 10:00:45 PDT 2014

roguerad @ruthcarlosmd @pfanderson I'm so much in favour of informed consent andpersonal responsibility that I can't explain! Seriously #jacr Thu Oct 23 10:01:20 PDT 2014

ruthcarlosmd Gr8 #JACR tchat as always. THX @jzayanian guest mod. @UMich tweeps@UM_IHPI FORUM 11/13, 12p ET in NCRC. research/policy collab in action. Thu Oct 23 10:01:24 PDT 2014

pfanderson @ruthcarlosmd @RogueRad Exactly. Have doc friend who chose no Tx for herThyCa. Her team freaked, but she is cancer free 20 years out. #jacr Thu Oct 23 10:01:26 PDT 2014

pfanderson @ruthcarlosmd @RogueRad Burden is education / information; doc informs,persuades; patient makes choice. #jacr Thu Oct 23 10:01:55 PDT 2014

pfanderson @RogueRad @ruthcarlosmd Awesome! Then it is 140 character confusion :) Weagree in essence. #jacr Thu Oct 23 10:02:41 PDT 2014

nxtstop1 Yes~ laborious,important RT @pfanderson @ruthcarlosmd @RogueRadBurden=education/information; doc informs, persuades; patient choses. #jacr Thu Oct 23 10:02:51 PDT 2014

jzayanian .@ruthcarlosmd T3 correcting handle: is @RadiologyACR implementing#choosingwisely recs? http://t.co/3HPJqf3fXd #jacr Thu Oct 23 10:03:22 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 23/24

eqhealth Thanks @ruthcarlosmd @jzayanian @JACRJournal for an informative chat thismorning. #jacr Thu Oct 23 10:03:29 PDT 2014

nxtstop1 RT @jzayanian .@ruthcarlosmd T3 correcting handle: is @RadiologyACRimplementing #choosingwisely recs? http://t.co/ntmKYAxfxX #jacr Thu Oct 23 10:03:35 PDT 2014

roguerad @pfanderson @ruthcarlosmd It's the curse of Twitter. If it was around in 1939France might have teamed up with Germany. Accidentally. #jacr Thu Oct 23 10:04:28 PDT 2014

grebeccahaines RT @UCRadSafety: T3: Lots of great evidence-based research in imaging out there,time to put it regularly into practice. Decision support t… Thu Oct 23 10:04:38 PDT 2014

jaffri RT @jzayanian: .@ruthcarlosmd T3 is @ACR implementing #choosingwisely recs?http://t.co/3HPJqf3fXd #jacr Thu Oct 23 10:04:44 PDT 2014

jaffri RT @nxtstop1: RT @jzayanian .@ruthcarlosmd T3 correcting handle: is@RadiologyACR implementing #choosingwisely recs? http://t.co/ntmKYAxfxX… Thu Oct 23 10:04:44 PDT 2014

2healthguru Really good @BrookingsMed session on ACOs progress and promise here:http://t.co/bnTb1ncod3 #jacr Thu Oct 23 10:04:49 PDT 2014

ruthcarlosmd Thx to everyone for gr8 discussion. symplur sez ~1.3M impressions. Top10@pfanderson @nxtstop1 @2healthguru @radiologyacr @jzayanian #JACR Thu Oct 23 10:05:03 PDT 2014

grebeccahaines RT @LLALO: #jacr Shared savings is a transitional period on road to risk basedmodels, ultimately capitation. ACOs need to learn & structur… Thu Oct 23 10:05:11 PDT 2014

nxtstop1 RT @ruthcarlosmd: Thx to everyone for gr8 discussion. symplur sez ~1.3Mimpressions. Top10 @pfanderson @nxtstop1 @2healthguru @radiologyacr… Thu Oct 23 10:05:16 PDT 2014

pfanderson @RogueRad @ruthcarlosmd OK, that got a belly laugh. :) Thanks! #jacr Thu Oct 23 10:05:31 PDT 2014

pfanderson RT @RogueRad: @pfanderson @ruthcarlosmd It's the curse of Twitter. If it wasaround in 1939 France might have teamed up with Germany. Accid… Thu Oct 23 10:05:36 PDT 2014

pfanderson RT @ruthcarlosmd: Thx to everyone for gr8 discussion. symplur sez ~1.3Mimpressions. Top10 @pfanderson @nxtstop1 @2healthguru @radiologyacr… Thu Oct 23 10:05:50 PDT 2014

10/23/2014 #JACR - Healthcare Social Media Transcript

http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=10-23-2014&shour=09&smin=00&tdate=10-23-2014&thour=10&tmin=15 24/24

pfanderson RT @2healthguru: Really good @BrookingsMed session on ACOs progress andpromise here: http://t.co/bnTb1ncod3 #jacr Thu Oct 23 10:05:58 PDT 2014

ruthcarlosmd more top10 #JACR @jbbc @ruthcarlosmd @jdimick @kristinahoque @roguerad@elinsilveous. BIG thx to @jzayanian for guest hosting. Thu Oct 23 10:06:16 PDT 2014

roguerad RT @ruthcarlosmd: more top10 #JACR @jbbc @ruthcarlosmd @jdimick@kristinahoque @roguerad @elinsilveous. BIG thx to @jzayanian for guest ho… Thu Oct 23 10:06:30 PDT 2014

nxtstop1 Reference Thanks RT @2healthguru Really good @BrookingsMed session onACOs progress and promise here: http://t.co/yIpylGzsAq #jacr Thu Oct 23 10:07:37 PDT 2014