When a Chorus Turns Into a Cacophony

Submitted by hci3-usr on Friday, May 13, 2016 - 07:09

Newtown, CT – May 13, 2016

When a chorus turns into a cacophony, it’s important for a conductor to step in – For several decades, in Massachusetts and beyond, that conductor was Dolores Mitchell. In the early part of this century, when quality and cost measurement of physicians and hospitals came to the fore, a cacophony soon ensued. Advocates and opponents pointed to intended and unintended consequences, to the relevance of process and outcomes measures and why some were better than others, to the need for speed and the importance of temperance. And in the midst of that cacophony, Dolores stepped in on behalf of the hundreds of thousands of employees and their family members whose interests she represented. In a state in which health care news are often “above the fold” in the Boston Globe, she used the purchasing power of the state employee benefits plan to implement programs that shed light on the significant differences in price and quality of physicians and hospitals. She paved the way for the type of transparency that many take for granted today, and despite the howls and cries from the agents of the status quo, she kept her compass on the true North: the interests and welfare of individual plan members and of those who pay for their care. In doing so, she turned the cacophony back into a chorus that has extended to states across the country. As she retires, she will be missed, especially at a time when a new chorus has now turned into a cacophony and requires leadership.

What this means to you – The recently released regulations on advanced alternative payment models (APMs) by CMS adds to the growing noise made by proponents and opponents of these new models. Medicaid plans in several states have launched mixtures of APMs that include primary care-focused total cost of care models, health system-focused total cost of care models, specialty care-focused bundled payment models. Commercial plans and Medicare have had similar yet varying approaches. And yet none is the same. For example, individual states, medical specialty societies and individual providers are all defining their own brand of episodes of care for use in bundled payment programs. To add to the cacophony, CMS is torpedoing some of its own “innovations”, disqualifying them as APMs, and ignoring the advice of the Congressionally-mandated Physician-focused Payment Model Technical Advisory Panel. And none of these efforts is using a common structure for defining episode of care, making it impossible to replicate and scale programs. While it’s not really essential for everyone to use the same episode definitions – after all we are still in the early phases of APM deployment – we should have a common way of structuring them in order to make them operational. And that’s why we’ve released a new API that makes all of our definitions and, more importantly, the data structure they were built on, open to all, and available for app developers. Ultimately, the cacophony can become a chorus if scalable operational solutions are built and used to power APMs, and that’s what will happen if we coalesce around a common data schema for episodes of care. We’ll all certainly miss Dolores’ leadership in Massachusetts, but we won’t forget what she taught us


Francois Sig


Francois de Brantes
Executive Director