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Doctors and Health Plans: Can Care Management Opportunities Reconcile the Hatfields and the McCoys?
I’m going to try something different in this blog posting. I’d like to introduce a fairly open-ended issue that 1) is of great importance, and 2) is highly debatable. I’ll be the first to admit that my thinking about this is half baked.
Here’s the issue. Over the coming years, will health plans and doctors:
- Continue to have adversarial relationship such as they’ve had over the past decades (ala Hatfields v. McCoys, cats v. dogs, oil and water), or
- Is there strategic potential for reconciliation and partnerships to emerge?
A headline in yesterday’s Wall Street Journal caught my attention and got me thinking (again) about the issue.
Doctors Assail United Health’s Threat of Fines [subscription required]
A new United Health Group Health, Inc. policy that threatens to fine doctors for referring patients to out-of-network laboratories for tests is mushrooming into a bitter dispute between the health insurance giant and many of the 520,000 in its networks nationwide.
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p dir=”ltr”>My first reaction to this was: “That’s really dumb. United is getting a great big black eye in the press and they’re really getting the docs mad. This is going to carry over to the doctors not wanting to work with United in many other ways”.
I’ve seen a lot of data suggesting that doctor trust of health plans is very low; having worked in health care for 25 years, I recognize that the antagonism between doctors and health plans runs very deep, and perhaps is irreparable.
But things are changing. I am aware that at least some health plans have articulated business strategies around repairing relationships with physicians and forming partnerships for the future. I hear mixed stories of success, and the WSJ article points toward ongoing bickering.
The emergence of disease/care management opportunities has the potential to change the dynamics of the playing field. There are forces bringing doctors and health plans together for the future:
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Collaboration over care management has the potential to create a win/win dynamic over cost reduction AND quality improvement. “Managed care” was a win/lose model — upside dollars negotiated by health plans were downside dollars for doctors. A recent article in Managed Care magazine explains the shift from a win/lose to a win/win dynamic; the article doesn’t specifically address doctors, but the same dynamic about care/disease management applies.
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Collaboration over information technology. I’m quoting from memory, but I remember a recent Markle Foundation report pointing out that 89% of savings from implementing health IT will accrue to health plans. Doctors could use the data from IT, but are unlikely to dig in to their own pockets to fund technology that saves $$ for the health plan. This seems like an opportunity for health plans and doctors to discuss common interests and strike a deal where health plans contribute to funding the technology if doctors agree to use the technology to improve quality and reduce costs.
So, should the Hatfields and McCoys get together for the future? Can the Hatfields and McCoys reconcile?
Your thoughts? How are things going between doctors and health plans in your community?
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If ever there was a time ripe for such reconciliation, it would appear to be now. The delivery system including physicians but more broadly referencing all those whom patients think of as their health providers and the Disease Management industry (or Care Mgt or PHM, take your pick) certainly should be able to find common ground today, given multiple converging and reinforcing factors that are pushing them to do just that. To name a few:
The need for improved health care value remains as high as ever with health care inflation running at 2-3X of general inflation with no end in sight
Medical home movement replacing yesterday’s gatekeepingĀ¯ with comprehensive, continuous care and care coordination
Consumerism displacing paternalism in the patient-provider relationship
CDHP w/ HSA/HRA skin in the game vehicles
Boomer Demographics/Psychographics we want what we want when we want it, and by God, we’ve got the discretionary income to get it!
Medicare Trust Fund looming insolvency remember when 2019 seemed a very long way away?
Telemedicine and remote patient monitoring are increasingly making healthcare unbound a reality for mainstream health management
EHR, EMR, Registries, PHR, RHIO slow adoption, but progressive spread nonetheless
Evidence-based medicine, ubiquitous (and democratized) access to evidence, Cochrane reviews, clinical guidelines
P4P in myriad forms, despite some provider skepticism, is gaining traction
Health as Human Capital realization by Fortune 500 employers health is much more than what health care providers provide, and the consequences of optimal health on productivity may exceed the value of health care costs by sevevral fold
CQM (more & better metrics, more measuring of care process & outcomes)
Increasing Quality transparency, Quality reporting, consumer use even though consumers are still inexperienced and inexpert at using these tools currently, their proliferation will slowly improve population quality literacy
So is this enough of a catalyst for DM-provider reconciliation on a large scale? It remains to be seen, but I am cautiously optimistic given what I perceive now as a gradual thawing of current relations and the prospect for substantially more areas of mutual self-interest in the future.
[…] adversarial relationships, according to Vince Kuratis, it’s time to lay down arms. In his post Doctors and Health Plans: Can Care Management Opportunities Reconcile the Hatfields and the McCoys?, Kruatis’s e-Care Management blog states that Health plans need to rethink financial […]