Trick or treat….only time will tell, but we do have some early signs, and it's a mixed bag. There's no denying that October has been a catastrophic month for the ACA. The rollout of the federal exchange is a disaster and there are more gremlins and goblins in that system than there were last night in all the towns and cities of the US. It will take more than the wave of a magic wand to get rid of them. This comes on the heels of other reversals that have the same root cause…expediency mixed with the delusion of being all-knowing and invincible. That's usually a bad combination and all the masked little heroes walking through neighborhoods yesterday know each superhero has a weakness. None is invincible. Perhaps this slice of humble pie before the pumpkin pie will recalibrate the important efforts under way so that they become the treats they were intended to be. One such treat could be the immediate and unfettered release of Medicare data to bring light to the darkness of provider performance…in particular cost performance. A group of large employers recently reiterated the request to free up these data to supplement the more limited data released by Medicare earlier this year. While the latter have been a very small treat, their interpretation can be very tricky despite good efforts to make sense of it. Another treat could be the proliferation of well-designed bundled payments coupled with changes in plan member benefits. The BPCI has been plagued with fits and starts, but providers are sticking with it and more are joining. We need to make sure they don't get tricked.
What this means to you – There's growing evidence that moving market share to the lower priced, better quality providers yields dividends for patients and employers. And on the heels of the CalPERS pilot, we published a short report with our friends at Catalyst for Payment Reform outlining how such a pilot could be reasonably scaled and expanded to better apportion the financial risk between payers, providers and patients. Separately, I've outlined new directions in bundled payments that are showing great promise and that should lead to further and more robust experimentation. While some of these concepts might be frightful to some, it will be quite the treat to all those who are willing to re-engineer their care delivery processes and innovate. We must remember that those who are the butts of the tricks today are the American people, the ones who are uninsured and left fumbling while the web site goes dark; the ones who can't see or understand prices for services while the data stay mysteriously locked up in dark caverns; the ones who are paying for care inefficiencies while operational incompetence mixed with arrogance delays progress in payment innovation. We can still turn these tricks into treats, and employers can lead the way.