Fundamental Freedom

Submitted by hci3-usr on Friday, February 19, 2016 - 06:58

Newtown, CT – February 19, 2016

The rumors of his demise were greatly exaggerated, and eventually Prometheus was freed – In November 2011, a report by a “think tank” overtly publicized the death of PROMETHEUS, spewing out fiction as fact and comments gathered in interviews as definitive truths. Since then the fiction has slowly but surely shown itself to be just that, and the published demise of a novel payment program has revealed itself to be the lie it was. Now, several years later, the first in a series of true Case Studies shows how alive and well the model is. During the past several years we have often cited the work done by Horizon Blue Cross and Blue Shield as an example of what can happen when a payer takes payment innovation seriously and devotes the resources to test, refine, and operationalize it. The truth is that after starting with the usual procedural episode suspects, Horizon moved on to condition episodes such as pregnancies, cancer care and heart failure. The truth is that the physicians and facilities engaged in the payment effort have improved their performance relative to non-participants. The truth is that patients are getting safer, more affordable health care. The truth is that the physicians are far more content in their practice of medicine and their relationship with their payer. The truth is that scaling up has proven hard but possible. The truth is that when you actually do something to make the world better instead of sitting back drinking lattes and taking pot shots, the world becomes a better place. The job isn’t over, but the truth is now self-evident.

What this means to you – As the country accelerates in deploying alternative payment models (APMs) there will be many lessons to be learned and shifts to make. And the guiding principle we should all adhere to has to be flexibility. Without flexibility Horizon would have been hard pressed to achieve what it has, and yet there continues to be a central tendency to reduce flexibility, in particular through the self-proclaimed “consensus” processes that flourish from Washington DC. These processes don’t really drive consensus because if they did the consensus would be to maintain the utmost flexibility in how payers, purchasers and providers are testing and deploying APMs. Instead, the “consensus” is to adopt one way of implementing because a few people who are paid to go to meetings want it that way. Take, for example, the new White Paper on Patient Attribution that has been released by the DC-based Learning Action Network. It essentially dictates that population-based payments “have to be” assigned to medical groups or health systems. No discussion, end of story. In much the same way, patients have to be attributed to a PCP and only in desperation should a patient be attributed to another provider. The patient, by the way, doesn’t have a say in the matter. The door on flexibility, on innovation, on disruption, is closed. So sayeth the establishment. Of course, much like the statements of yore by the other establishment “think tank”, wishful thinking does not reality make, despite their desire to do so. Be weary therefore of what you hear coming from these groups, and don’t take their word as truth because it isn’t. The truth is that patients should be able to designate whomever they want as the guide of their care team. In fact they should be able to designate their own care team, regardless of the artificial institutional barriers that are drawn up for providers and against patients. And providers should be free to do the same. Our goal is to ensure that payment supports that fundamental freedom because that’s the only way care can ever be patient centered. The truth is freeing, even if it takes time to be freed.

Francois Sig

Francois de Brantes
Executive Director