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Integration
Despite Limited Penetration, Integrated Delivery Systems Have Advanced Chronic Care
The 1990’s experiment around development of integrated delivery systems (IDSs) mostly did not take root. This experiment was primarily about financial integration — doctors joining with hospitals so that they could together contract with health insurers for capitated reimbursement, hospitals starting their own health plan, or hospitals buying physician practices as a way of guaranteeing a future base of patients and revenues.
The systems and processes needed jointly to manage financial and clinical risk were an afterthought; information technology was not […]
One More Dark Cloud in the Stormy Skies of Medicare DM
Mathematica Research has just released a report: The Evaluation of the Medicare Coordinated Care Demonstration: Findings for the First Two Years. It’s not pretty.
Section F of the Executive Summary is entitled “Synthesizing the Findings: What Works, and What Doesn’t”. That section begins:
Given that few of the programs have shown convincing evidence to date of reducing beneficiaries’ need for hospitalizations and saving money or of improving the quality of care received, there is relatively little assessment that can be done yet […]
AARP On the Fence About Care Coordination Roles
Just in case this particular item hasn’t yet reached the top of your own to read pile, let me bring to your attention recent testimony to the Senate Finance Committee on Medicare Payment of Physician Services.
The testimony was presented on March 1 by Byron Thames, MD, an AARP Board member. With over 35 million members, AARP is the leading nonprofit, nonpartisan membership organization for people age 50 and over in the United States.
Here are my take-away points from Dr. Thames […]
Porter/Teisberg JAMA Article: Out-of-the-Box or Out-of-Touch?
“In theory, there is no difference between theory and reality. In reality, there is.” Yogi Bera
Out-of-the-box thinking is good; out-of-touch thinking is not. Dr. Porter and Teisberg’s (PT’s) recent article in JAMA “How Physicians Can Change the Future of Health Care” is disappointing, unrealistic and dangerous.
Disappointing: Please Answer the Challenges About Why Your Theory isn’t Workable
Unrealistic: Money Does Matter a Lot
Dangerous: Measuring Process in Health Care Does Add Value
What’s so seductive about their writing is that about 90% […]
Today’s BFO: How can P4P Work W/O a QB?
Translation Todays blinding flash of the obvious (BFO): How can you expect pay-for-performance (P4P) programs in Medicare to work with out a designated physician quarterback (QB)?
Please allow me to elaborate.
P4P programs are based on two assumptions:
Patients are assigned to a physician or a practice that will have primary responsibility for their care, and
That a meaningful fraction of the care physicians deliver is for patients from whom they have primary responsibility
Wouldn’t you expect that this would be problematic for older (Medicare) […]
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