Newtown, CT – November 25, 2011
For every pro, there always seems to be a con (and vice versa), which can lead to inaction – The recently released final regulations for Accountable Care Organizations have, more than others, elicited strong comments from both pros and cons. In a BNA-sponsored paper, Lara Cartwright-Smith, Jane Hyatt Thorpe, and Sara Rosenbaum articulate many arguments as to why the final ACO regulations strike a good balance, and provide an opportunity for providers to organize to deliver value. On the other side, a recent posting on the Health Care Blog relates a talk given by the FTC Commissioner who clearly articulates his concerns about the risks inherent in allowing providers to consolidate. And herein lies the rub. If we all always acted like knights, then there wouldn't be much to worry about as provider organizations consolidate into large (and powerful) institutions. However, several hundred years of economic theory and observations of human behavior lead us to conclude that many will behave like knaves and simply (ab)use this new market power to optimize institutional self-interest rather than societal interest. A study commissioned by Catalyst For Payment Reform and conducted by Paul Ginsburg gives us a legitimate reason to share the FTC Commissioner's concerns. Counterbalancing these concerns are the incentives in the final regs, which are quite appealing, and so, perhaps, the knavish behavior will, in fact, turn out to be quite knightly, and the cons will turn into pros.
What this means to you – The ultimate test of knavish and knightly behaviors is in the public light. Knights don't fear the light of day, quite the contrary; they relish it. Knaves prefer the shadows and fear transparency. They insist on having clauses in their plan contracts that prevent plans from sharing data on their performance, or from attempting in any way to shift market share. They will abuse power. In fact, they already do. So how do we tell the knights from the knaves, the pros from the cons? One of the better resources is WhyNotTheBest.org, a public site, courtesy of the Commonwealth Fund, that assembles a wealth of information on hospitals and, increasingly, physicians. In addition, employers large and small have an obligation to ask their plans about the gag clauses in their provider contracts, to inform each and every one of their employees about the presence of these gag clauses, and to remind them not to be conned by the knaves.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.