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Over at CommonHealth this week, Debra Geihsler proposes a coordinated care model as a solution to the looming PCP crisis . (Debra is CEO of Harvard Vanguard Medical Associates, which, for those of you not from around here, is the not-for-profit medical group that used to be the staff part of former part-staff-model HMO Harvard Community Health Plan; the HMO is now Harvard Pilgrim Health Care.) This sounds like an intriguing idea, but the solution seems to be constructed from the perspective of the provider and payor (lack of PCP resources, high cost of chronic customer tracking are) rather than the public (though she does note the access issue -- i.e., lack of timely access to PCPs). I wonder, to what extent has HVMA implemented this approach? To what extent can it do so without changes in payor contracts? I'd be interested in hearing more about what HVMA means, exactly, by coordinated care. As described by some other provider organizations, it sounds to me just like what the function of a good PCP is supposed to be. My own care through HVMA seems to be coordinated through my PCP, through annual physicals and advice about things like diet and exercise, as well as through encounters with the system between annual physicals.

Q: I may have a job offer soon with a newspaper and I am wondering at what point should I talk about relocation costs, etc. I've only worked for Knight Ridder and each time it varied by paper. At one place, it was the same for everyone (I think around 6 weeks pay). I later went to another KR newspaper and this wasn't mentioned until after I accepted a job and the salary. The editor then gave me the name of someone in HR and we kind of worked out what the moving expenses would cost. I think I got gypped, though, after talking to other reporters who told me they actually got a bonus. Normally, I don't bring up salary or moving costs during interviews. I've always waited to discuss that when/if a job proposal is made. What are your thoughts on that. I don't want to be aggressive during an interview and make it look like all I care about is money (because I don't). Still, I want to get the best relocation possible. Thanks for any suggestions. Dan A: The time to negotiate relocation costs is while you are considering an offer. Talking about relocation before you have been offered a job is presumptuous and talking about it after you have accepted costs you your bargaining clout. The whole package -- pay, costs and vacation time -- should go into your decision. Policies may vary within companies. Some moves will naturally be much more expensive than others, some people discover magazine re more highly sought than others and some are just better at bargaining.

Back again after spending much of the last three weeks in the internet interdit zone of Birkencraig - an island at Lake of the Woods, in the Gordon family for 100 years [built by C W Gordon, Mary's grandfather], where, among other things, personal emergency response systems spent way too much time learning the unfortunate reallities of trying to get a composting toilet working with a big crowd of producers waiting, hoping . . .[who knew a solar fan could go in the wrong way?]. Prior to that I spend a couple of weeks over-building a back deck until Mary wisely said, 'Maybe that's enough for now.' I still have a bit of holiday time left so am puttering around, giving my daughter a hand in her apartment. Emerging out of cyberless space-time, I found myself tagged by Jamie for a book meme. [Jamie had nicely sent me an email wondering if I had dropped off the planet]. Books are, for me, strongly connected to summer [the only time of year I get much/any pleaasure reading done]. So here goes [I'll leave the Bible off the list, though it would show up in a number of categories] One book that changed your life: This was the hardest one. Many came to mind: Codendent No More [helped me let go], Men are from Mars, etc.

Back again after spending much of the last three weeks in the internet interdit zone of Birkencraig - an island at Lake of the Woods, in the Gordon family for 100 years [built by C W Gordon, Mary's grandfather], where, among other things, I spent way too much time learning the unfortunate reallities of trying to get a composting toilet working with a big crowd of producers waiting, hoping . . .[who knew a filter syringe olar fan could go in the wrong way?]. Prior to that I spend a couple of weeks over-building a back deck until Mary wisely said, 'Maybe that's enough for now.' I still have a bit of holiday time left so am puttering around, giving my daughter a hand in her apartment. Emerging out of cyberless space-time, I found myself tagged by Jamie for a book meme. [Jamie had nicely sent me an email wondering if I had dropped off the planet]. Books are, for me, strongly connected to summer [the only time of year I get much/any pleaasure reading done]. So here goes [I'll leave the Bible off the list, though it would show up in a number of categories] One book that changed your life: This was the hardest one. Many came to mind: Codendent No More [helped me let go], Men are from Mars, etc.

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Back again after spending much of the last three weeks in the internet interdit zone of Birkencraig - an island at Lake of the Woods, in the Gordon family for 100 years [built by C W Gordon, Mary's mlm lead list randfather], where, among other things, I spent way too much time learning the unfortunate reallities of trying to get a composting toilet working with a big crowd of producers waiting, hoping . . .[who knew a solar fan could go in the wrong way?]. Prior to that I spend a couple of weeks over-building a back deck until Mary wisely said, 'Maybe that's enough for now.' I still have a bit of holiday time left so am puttering around, giving my daughter a hand in her apartment. Emerging out of cyberless space-time, I found myself tagged by Jamie for a book meme. [Jamie had nicely sent me an email wondering if I had dropped off the planet]. Books are, for me, strongly connected to summer [the only time of year I get much/any pleaasure reading done]. So here goes [I'll leave the Bible off the list, though it would show up in a number of categories] One book that changed your life: This was the hardest one. Many came to mind: Codendent No More [helped me let go], Men are from Mars, etc.

Q: I may have a job offer soon with a newspaper and I am wondering at what point should I talk about relocation costs, etc. I've only worked for Knight Ridder and each time it varied by paper. At one place, it was the same for everyone (I think around 6 weeks pay). I later went to another KR newspaper and this wasn't mentioned until after I accepted a job and the salary. The editor then gave me the name of someone in HR and we kind of worked out what the moving expenses would cost. I think I got gypped, though, after talking to other reporters who told me they actually got a bonus. Normally, I don't bring up salary or moving costs during interviews. I've always waited to discuss that when/if a job proposal is made. What are your thoughts on that. I don't want to be aggressive during an interview and make it look like all I care about is money (because I don't). Still, I want to get the best relocation possible. Thanks for any suggestions. Dan A: The time to negotiate relocation costs is while you are considering an offer. Talking about relocation before you have been offered a job is presumptuous and talking about it after you have accepted costs you your bargaining clout. The whole selling notes ackage -- pay, costs and vacation time -- should go into your decision. Policies may vary within companies. Some moves will naturally be much more expensive than others, some people are more highly sought than others and some are just better at bargaining.

Back again after spending much of the last three weeks in the internet interdit zone of Birkencraig - an island at Lake of the Woods, in the Gordon family for 100 years [built by C W Gordon, Mary's grandfather], where, among other things, I spent way too much time learning the unfortunate reallities of trying to get a composting toilet working with a big crowd medical coding programs f producers waiting, hoping . . .[who knew a solar fan could go in the wrong way?]. Prior to that I spend a couple of weeks over-building a back deck until Mary wisely said, 'Maybe that's enough for now.' I still have a bit of holiday time left so am puttering around, giving my daughter a hand in her apartment. Emerging out of cyberless space-time, I found myself tagged by Jamie for a book meme. [Jamie had nicely sent me an email wondering if I had dropped off the planet]. Books are, for me, strongly connected to summer [the only time of year I get much/any pleaasure reading done]. So here goes [I'll leave the Bible off the list, though it would show up in a number of categories] One book that changed your life: This was the hardest one. Many came to mind: Codendent No More [helped me let go], Men are from Mars, etc.

Over at CommonHealth this week, Debra Geihsler proposes a coordinated care model as a solution to the looming PCP crisis . (Debra is CEO of Harvard Vanguard Medical Associates, which, for those of you not from around here, is the not-for-profit medical group that used to be the staff part of former part-staff-model HMO Harvard Community Health Plan; the HMO is now Harvard Pilgrim Health Care.) This sounds like an intriguing idea, but the solution seems to be constructed from the perspective of the provider and payor (lack of PCP resources, high cost of chronic care) rather than the public (though she does support our troops ote the access issue -- i.e., lack of timely access to PCPs). I wonder, to what extent has HVMA implemented this approach? To what extent can it do so without changes in payor contracts? I'd be interested in hearing more about what HVMA means, exactly, by coordinated care. As described by some other provider organizations, it sounds to me just like what the function of a good PCP is supposed to be. My own care through HVMA seems to be coordinated through my PCP, through annual physicals and advice about things like diet and exercise, as well as through encounters with the system between annual physicals.

Q: I may have a job offer soon with a newspaper and I am wondering at what point should I talk about relocation costs, etc. I've only worked for Knight Ridder and each time it varied by paper. At one place, it was the same for everyone (I think around 6 weeks pay). I later went to another KR newspaper and this wasn't mentioned until after I accepted a job and the salary. The editor then gave me the name of someone in HR and we kind of worked out what the moving expenses would cost. I think I got gypped, though, after talking to other reporters who told me they actually got a bonus. Normally, I don't bring up salary or moving costs during interviews. I've always waited to discuss that when/if a job proposal is made. What are your thoughts on that. I don't want to be aggressive during an interview and make it look like all I care about is money (because I don't). Still, I want to get the best relocation possible. Thanks for any suggestions. Dan A: The time to negotiate relocation costs is while you are considering an offer. Talking about relocation before you have been offered a job is presumptuous and talking about it after you have accepted costs you your bargaining clout. The whole package -- pay, parent directory warez osts and vacation time -- should go into your decision. Policies may vary within companies. Some moves will naturally be much more expensive than others, some people are more highly sought than others and some are just better at bargaining.