Comments on: HealthSpring “Gets” Physician Engagement.

By: Jade Borg

Jade Borg — Fri, 01 Aug 2008 16:40:40 +0000

Jade Borg
http://www.gpjobsaustralia.com/

By: Mike Barrett

Mike Barrett — Wed, 05 Mar 2008 16:05:52 +0000

A weak link for HealthSpring, at least as its approach emerges in these selected excerpts, is the possible neglect of the role of clinicians other than MDs. I’m would think that cost-effective chronic health care will involve many more “home visits” by affordable Medicare-certified home health nurses than by expensive docs. The docs are the right choices for care coordination, but for actual care delivery in the home, I fear relying on docs will dry up HealthSpring’s funds fast.

By: Vince Kuraitis

Vince Kuraitis — Sun, 10 Feb 2008 18:50:22 +0000

Your comment shows your great wisdom, Dr. Sidorov. Indeed, there is potential for the good, the bad AND the ugly.

What’s one person’s “appropriate financial incentive” can be anothers “bribe or payoff”.

My 2nd job out of school was with National Medical Enterprises (NME) back in the 80s. NME was a for-profit hospital chain with 100+ hospitals around the country. The marketing strategy was to market “to and through” doctors, with the goal being to get doctors to hospitalize patients to boost the bottom line. NME was an ethically challenged company. Many of their tactics to put “patients in beds” were questionnable.

The same potential exists here. While one of the central lessons from Medicare Health Support is the need for greater integration and engagement of physicians in care coordination processes, it’s not difficult to imagine inappropriate incentives and tactics employed by health plans to encourage doctors to keep patients OUT OF beds. The lines are not clear, and the pendulum could swing TOO far.

By: Jaan Sidorov

Jaan Sidorov — Sat, 09 Feb 2008 13:32:32 +0000

As you mention, part of the physician engagement strategy appears to rest on tiering. Unless I’m wrong (and I could be) that isn’t necessarily engagement, it’s exclusion of physicians that don’t meet criteria. In addition, much of the engagement seems to be targeting coding behavior; by demonstrating a prevalence of complex medical conditions, an MA Plan can command a higher payment from CMS. That’s not necessarily enlightened medical management with cost savings, that’s revenue.

One way to gauge physician friendliness is to look at the prior authorization requirements. Based on my review, PA is required for a lot of high dollar radiology studies when ordered by PCPs. It also appears to be done the old fashioned way – an 800 number or a fax.

That being said, kudos to HealthSpring for aggressively a) sharing their revenue with the providers (it appears to be based on quality and maybe some sort of upside gainshare? and b) emphasizing the PCPs and bringing population care strategies down into the weeds of the delivery network (aka disease management, Ver 2.0) in their overall strategy.

My overall impression is that to make it in today’s MA market you have to be good at all three: the good, the bad AND the ugly.