HCI3 Update from the Field: Saying It Does Not Make It True

Submitted by francois.debrantes@hci3.org on Friday, June 1, 2012 - 12:43

Newtown, CT – June 1, 2012

As the proverb goes, the person who says something cannot be done should not interrupt the person doing it. Nine months ago we were almost interrupted by an out-of-date and misleading report that said that bundled payment had not been and could not be implemented. That was wrong then and even more so today. In a report released this week, co-authors Michael Bailit and Megan Burns detail the results of a comprehensive review of private sector bundled payment implementations in the US. In it, they reveal that half the sites have moved to full implementation, including contracts and paid bundles, with the other half at various stages of pre-implementation and planning. Think about it. Nine of nineteen sites are up and running. That's a fact, and tells a very different story than the headline-grabbing fiction published in the fall. There's no doubt the current implementation sites have still a distance to travel to fully automate all their operational processes, but they have contracts in place, they have engaged providers, and behaviors are changing for the better.

What this means to you – The hand wringers and the talkers have wasted enough of our time, and shame on us for allowing them to do that. They spend their time trying to convince us that we haven't thought through all the unintended consequences, or that the implementations are too bold and should be scaled back. But in the meantime, bold and broad action (taken with a measure of reserve to mitigate adverse effects) is in play, and having an impact. Employers casting a light on price and quality of providers in an area are helping to shape a new, more competitive market for healthcare services. Plans tying compensation to the value of care delivered are helping to reshape the delivery system. Providers taking an active role as supply chain managers and stewards of patient care are reducing costs by 30% while increasing quality. Have we thought through all the unintended consequences? Have we planned for every eventuality? Will we be able to perfectly measure the effects of each intervention? No, no, and no. And so what? As long as we observe, continue to make adjustments, and minimize the misalignments of incentives and behaviors, we'll stay one step ahead, and keep doing it while they keep saying it can't be done. Count them….nine out of nineteen sites implementing bundled payments. How many implementations have the hand wringers and talkers launched? Zero. Which camp do you want to be in?


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