HCI3 Update from the Field: Common Sense… Astonishing

Submitted by francois.debrantes@hci3.org on Friday, July 12, 2013 - 12:13

Newtown, CT – July 12, 2013

"Nothing astonishes people so much as common sense and plain dealing", sayeth Ralph Waldo Emerson – And this week two friends remind us in their writings that common sense is just that. First, Judy Hibbard and her colleagues report that activated patients are more likely to rate their physicians higher in patient experience of care surveys. The upshot is that physicians, many of who dread the prospect of being held accountable financially for patient experience of care (just read the rabid responses to the WSJ debate on P4P), can influence those scores positively by increasing the activation of patients. Second, Judy Feder analyzes the current level of profitability of post acute care providers and notes that the simplistic bundling in effect is likely sub-optimal. Again, pretty much common sense. Bundling stay costs, or just post acute costs doesn't do a lot, unless you also bundle in avoidable complications. That's the purpose of the bundles being done by commercial payers today, and that might be done at some point by CMMI. But until that changes, let's not be surprised that costs sky-rocket post acute. After all, if the patient leaves the SNF because of a complication and comes back a few days later, another round of bucks drops. Not sure who thought that one up, but it sure as heck lacked common sense.

What this means to you – Patient activation can be increased. For several years I worked on such a program at GE, and it worked. After all, it is common sense. If you help consumers understand where to find information on their conditions, and the information is presented in laymen terms, they will act on it. Why wouldn't they? Consumers across the globe do it every day for complex and less complex issues – from selecting colleges for kids to buying houses to making financial investments. And they do it as well for health care. Don't you think that CalPERS employees were activated when they realized that they would pay the overage on knee replacements above the $30K reference price? Don't you think that hundreds of thousands of patients are activated when they find out they have cancer? Of course they are. And when the physician they see treats them as a customer instead of a child, patient experience of care increases (and so does compliance with treatment recommendations). And when we join activated consumers with true bundled payments, a real market for health care services will emerge, which will undoubtedly astonish those without much common sense.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org