HCI3 Update from the Field: When Does “Can’t” Become “Won’t”

Submitted by francois.debrantes@hci3.org on Thursday, June 9, 2011 - 02:45

HCI3 Update from the Field – Newtown, CT

When does "no we can't" become "no we won't" – when the technical and operational barriers to implementing an innovative or disruptive program have been removed. At that point, what's left is the unwillingness to innovate or disrupt, not the ability. Many employers over the years have been met with "no we can't" from their plan administrators, and then spent the following years creating the prototypes, figuring out the operational bugs, and then presenting the solutions back to the same or different TPAs. At that point, the "can't" either becomes a "won't", or the no gets converted to a yes. It continues to fascinate me how many times the "can't" gets converted into "won't". A couple of recent examples include a plan refusing to create a price transparency tool for a large national employer, and another refusing to help a large employer identify and then steer employees to higher value facilities for certain procedures. During the past three years, supported by a grant from the RWJF and another from the NYSHF, we've solved the technical and operational barriers for employers and their TPAs to implement episode of care payment. As mentioned last week, there are now fully scalable solutions that can plug into existing claims adjudication systems, and contract addenda templates to existing plan-provider contracts. We've even developed a couple of short videos to help employers and providers understand the mechanics of episode of care contracting. We've basically made it impossible for TPAs to say "no we can't" when asked by an employer to implement episode of care payment. They now have to say: "no we won't". They might have very good reasons for doing so, and those reasons should be explained clearly to the employers ultimately footing the health care bill.

What this means to you — employers have to stop wasting their money on those who say they won't and focus on those who will.Until the market punishes those who seem content with the status quo in favor of those who are willing to innovate, not much will cause the "wont's" to become "wills". And that's true on the payer and provider sides.There are many of both who are taking risks, disrupting their business models and the status quo, and you should seek them out avidly and give them your business. If we fail to move to those who will, then we will forever be stuck with those who won't. The solutions are actually quite simple. They simply have to be applied.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.