Newtown, CT – February 3, 2012
If, as recently reported by the CBO, high touch care management and payment reform work, why aren't they being widely deployed? This is our collective $500 billion question, because that's roughly what would be saved if you add up the impact from these interventions. With that much at stake, public and private sector payers should be rushing in. Some are, but many aren't. Our work suggests that incentives matter and impact behaviors, so let's examine who would significantly benefit (or not) from these interventions.
- Those who would benefit – First and foremost, patients. They would receive high-touch and effective care, and it would cost less. Second, those who pay for care. They might finally get the much-hyped bend in the cost curve. Of course, patients, employees and even employers are simply not well organized as a collective voice, and therein lies the rub. Because we now turn our attention to those who might lose out from these interventions.
- Those who wouldn't benefit – For the most part it's vendors of many stripes. For example, what would all the care/disease management vendors do if care management was finally back in the capable hands of physicians? What would happen to all those who sell expensive durable medical equipment, lab and other diagnostic tests if physicians and hospitals were no longer rewarded for the volume of services delivered? And, finally, what would happen to the ecosystem of brokers, consultants and others who feed off the status quo, constantly selling solutions that are basically ineffective? They would all have to recycle themselves to delivering value as opposed to piling on to the inefficiencies of the current system. Of course, they're very well organized and routinely walk the halls of Congress making sure the trough stays wide and plentiful.
What this means to you – Every time you contract for services or enter into a negotiation with a vendor, ask yourself this basic question: Are they benefiting from the status quo? If their fees (like those charged for disease management or patient "coaching") would decrease or disappear if physicians took over that function, then they're not on your side. If their commissions rise with the increase in health care costs and insurance premiums, then they're not on your side. If their bottom line fattens while yours gets thinner, then they're not on your side. And if they're not with us, they're against us, despite claims to the contrary. So it's time to get organized, to coalesce the forces of change against the forces of the status quo, and to push for the massive and immediate implementation of proven winning interventions. Start by joining the many implementations that are off the ground, and ask your health plans to join as well if they aren't already. Become a member of Catalyst for Payment Reform and your local business coalition on health. Or you can keep having your pockets picked and your bottom line thinned out. It's up to you.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.