A third of US health care dollars are spent on treatments (see the Dartmouth Atlas) that are questionable/doubtful/could have been avoided if the chronic condition was addressed.
That’s $7 trillion over ten years, and if we could snap our fingers and only pay for what we should, that would cover all Americans, with the rest paying off the war debts and giving every kid a college education.
Back here in the real world, precious little has been done – locally or systemwide or in Congress – to take on this biggest of all issues. Fortunately, the fine folks up in Massachusetts have seen fit to jump into reimbursement restructuring in a major way.
The Special Commission on the Health Care Payment System has come up with a very solid set of recommendations, including (quoting from their report):
* A global payment system in which providers would receive a payment per person, adjusted for patients’ health status [emphasis added] and other factors to ensure that they are compensated fairly for their patients’ health care needs. Payments would also be based on meeting common core performance measures to ensure high quality care.
* An emphasis on patient-centered medicine, with doctors and other providers providing coordinated, evidence-based, high-quality care for patients. In addition to providing more effective care for patients, this approach will also help to reduce health care costs in the longer term.
* A careful transition to global payment within five years, during which “shared savings” would serve as an interim payment model to help some providers become more familiar with global payment with no or reduced exposure to risk. There would also be infrastructure support for providers to facilitate the transition to global payments, including technical assistance and training and information technology.
Say what you will about Massachusetts; while the rest of us are talking endlessly, they are doing something. Not all of it is right, and some is pretty questionable, but I applaud the Commonwealth’s initiative. We are all learning much from their efforts.
Jul
17
Joe– Ecclesiastes was right. There is nothing new under the sun. Starting back in the 70s, HMOs have tried many variations on what MA is now reinventing. No, not exactly the same thing, but close enough to make comparisons. Overall, what we have all found is that global medicine– and throw in evidence based while we’re at it, although there are still very few really good EB medicine standards out there– does two things. It works very well for people who have standard medical problems in normal bodies. It absolutely does not work well for those of us, like me (yes, I’m selfish in this regard), who seem to have nothing but zebras– very unusual presentrations of rare conditions in a non standard body. GEB (global evidence based) medicine creates a new version of have and have not– the majority for whom it works OK most of the time and the large minority for whom it can be fatal. We have been down this track. A couple of friends died far too soon because their HMOs could not or would not deal with medical outliers competently. That’s why health care is different. We still can’t get mortgages right, but now we are going to make the rules for the human body? Bon chance, mes amis.
Joe: Ecclesiastes was right: there is nothing new under the sun. GEB (global, evidence based) medicine is just a new version of various plans tried since the 70s by the HMOs. Not exactly the same, but close enough for comparisons. What we already know is that this approach also creates winners and losers and the latter are often dead as a result. GEB medicine will work OK for people who have the usual diseases in their standard bodies. It will not work well for people (like me) who have unusual presentations of rare diseases in non-standard bodies. We have already been down this road. I have a number of dead friends whose HMOs could not or would not treat their outlier conditions competently, or at all. GEB sounds nice and scientific, but it’s really old wine in new bottles. We can’t even figure out how to make mortgages work and now we are fearlessly making rules for human bodies? Bon chance, mes amis.
Sound great is the reimbursement to the providers sufficient enough to attract the best and brightest to how ever many years of education to join the ranks of the salaried medical professional? That would be great. How does the payment structure reward excellence?
The press release was light on details about the payment methodology they plan to use. Does anyone happen to know if it’s the PROMETHEUS ECR (Evidence-informated Case Rate) payment methdology? (See http://www.prometheuspayment.org/ for all the gory details.)
You had me right up until the “shared savings” things. You’re telling me Massachusetts is going share the savings from “waste and excess” with the same people who have been doing the wasting?
It sounds more like paying the neighborhood bully to stop breaking my window.
It would be a little easier to swallow if you just told me it’s what we have to pay providers to get them to do what they should have doing all along.
I’ll be interested in hearing how much it costs to save.