Newtown, CT – September 30, 2016
When Atticus Finch talks about walking around in another man’s skin, he takes a specific spin to the older adage of walking a mile in someone else’s shoes, but the point is clear – Perhaps a spin on this old dictum for the ivory tower dwellers would be to avoid imposing on others their ideas until they’ve spent time living with the consequences of the implementation of those ideas. That may have avoided the many shortcomings of the current Medicare ACO models, which its original proponents and enforcers – Rick Gilfillan and Elliott Fisher – are now recognizing because they have to endure them. The common mistake made by many in the “intellectual elite” is not only that they know best, but that they know best for everyone. And as our friends Jeff Goldsmith and Lawton Burns remind us, there are reasons why these bright ideas never take off. Oftentimes it has to do with the great cultural diversity of the country that has led to the development of different structures and organizations of care. While some of these structures can and will adapt to new incentives, the adaptation only occurs if the incentives are designed with the specific needs of patients at their center. And a study in Health Affairs reaffirms this important and essential point of focusing on the improvement of care for the patient as the driver for process change and, consequentially, the driver for changes in provider organizations and structures. There’s nothing really new here, but unless we continue to remind ourselves that designing payment models should, first and foremost, be done to encourage process reengineering around the needs of patient populations, we’ll continue to waste valuable time and tons of resources.
What this means to you – It’s just a basic fact of living in a large and diverse country, made up of individuals from around the world with various cultures, that there will be many solutions to a problem, not one. It’s also a basic fact that however smart the intellectual elite thinks it is, it’s never smarter than the collective wisdom of everyone else. I know that’s a hard lesson for them to learn, but until they do, we will continue to pay for their arrogance. That’s why we, and now dozens of members of Congress, have written to Andy Slavitt asking him to not implement this latest round of proposed mandatory bundles. As readers of this missive know, HCI3 is a forceful supporter of episode of care programs, mostly because they engage physicians at the point of care, around diseases, illnesses, and treatments that they focus on, and encourage them to improve the outcomes of patient management. So when we see proposals of new payment models, whether voluntary like the MSSP, or mandatory like the CJR, that are poorly designed, we militate against them, because we know, for working in the field every day, that there are ways of designing these programs while minimizing their flaws, respecting the diversity of this country, and therefore helping them to thrive instead of dying on the vine. We’ve walked in the shoes of everyday patients, neighborhood physicians, community hospitals, small and large health plans, and that’s truly what makes a difference. It always has.