Newtown, CT – January 9, 2016
As we kick off this new year, a few resolutions are in order, from us and everyone else working to improve the affordability and quality of health care – First and foremost, let’s take off the blinders. So far, much of the movement on alternative payment models has been done with institutional blinders on. Patient-centered medical homes, which are really PCP-focused payment models; procedural bundles, which are really facility-focused payment models; and ACOs, which are health system-focused payment models – all share the common element of centering the payment around a specific form of provider organization instead of the patient. Let’s resolve to design payment models around the defined needs of patients, focusing on the functions of the delivery system that are required to meet those needs, and let the delivery system reshape itself. Second, let’s do the same for quality measurement and improvement. Again, today, most quality measurement is provider-centric and not patient-centric. Until we migrate the lens of measurement from a specific process the provider has done or not done, to what happens from the patient’s lens, we simply won’t make the leaps in quality that we need to. Third, let’s stop doing really silly things that we all know are silly but fail to systematically call out. That includes encouraging further provider consolidation, shifting unmanageable risk on providers, promoting benefit plans that insulate consumers from all responsibility or, conversely, financially penalize them when they want to actively manage their conditions.
What this means to you – Before we can unleash the creative and innovative forces that will fundamentally reshape the industry to the benefit of consumer-patients, we must stop bad practices and shed off the yoke of idiotic policies. Unfortunately these abound to the point where it’s almost impossible for those who espouse them to admit how bad they are. So it is up to the rest of us to call them out, all the time, even to the point of being unbearable, because the burden we are putting on them is nothing compared to the burden they are hoisting on the shoulders of every American, and it has to stop. Our resolve will be unwavering, but it simply isn’t enough. Everyone that wants to see genuine change happen must be equally unwavering. So look around at the policies you are currently implementing and that you know are holding back progress. Call them out, list them all, and hang them in front of you so that you have to look at them every day. But more importantly, resolve to cross them out, one at a time, and don’t stop until you’re done.
Francois de Brantes