Comments on: Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/ Chronic Disease Management • Technology • Strategy • Issues and Trends Tue, 27 Jul 2010 09:53:43 -0600 http://wordpress.org/?v=2.9.2 hourly 1 By: Alister Lane MD http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-12054 Alister Lane MD Tue, 14 Jul 2009 07:40:35 +0000 http://e-CareManagement.com/?p=848#comment-12054 Thanks for the interesting post, it provides a lot to think about for everyone involved. As long as physician groups are given complete visibility into the flow of funds from their source then at least this gives them control and they can make good judgements based on this. Thanks for the interesting post, it provides a lot to think about for everyone involved. As long as physician groups are given complete visibility into the flow of funds from their source then at least this gives them control and they can make good judgements based on this.

]]> By: Rachel Clarkson http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-11960 Rachel Clarkson Thu, 28 May 2009 17:02:30 +0000 http://e-CareManagement.com/?p=848#comment-11960 I agree with Warren, this needs to be deeply considered. Thanks for the post I agree with Warren, this needs to be deeply considered. Thanks for the post

]]> By: Randy Bak http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-11918 Randy Bak Mon, 11 May 2009 13:55:38 +0000 http://e-CareManagement.com/?p=848#comment-11918 Warren- You make an important point. This effort is a reaction to exactly that experience--failed capitation of the 1990's. Plans put all the risk on the physician groups in hide-the-ball finance arrangements. The CPM is different in some key ways: --physician groups are given complete visibility into the flow of funds from their source. It is what it is. --the administrative data stream of care delivery is given to the physician groups as quickly as it arrives in plan systems. Moreover, wherever possible, it is analyzed and prepared for presentation to the line clinicians, to help manage patient care and be stewards of that funding. --this new kind of payer uses its economies of scale to offer technology tools in clinical care and practice management. --it uses these economies of scale to develop clinical guidance free of bias introduced by pharma or PBM back-end deals. If their is a bias, it is toward care that makes sense for the line clinician. --this scale also creates a community of physician organizations operating under similar circumstances. The plan facilitates sharing among these groups. Information asymmetry and fragmentation of care delivery have been used by intermediaries to exploit the massive flow of funds from society to those who need health care. This practice has been executed so thoroughly that it is unclear whether current practitioners can change. Physician groups have been driven into near learned helplessness. Re-aligning participants and their contracts (nothing misty and utopian here) around payment and information that drive better care is the secret sauce. "Capitation of the '90's" is exactly what the CPM abhors. If the paper doesn't make that clear, please help us do a better job of making that clear. rb Warren-
You make an important point.
This effort is a reaction to exactly that experience–failed capitation of the 1990’s. Plans put all the risk on the physician groups in hide-the-ball finance arrangements. The CPM is different in some key ways:
–physician groups are given complete visibility into the flow of funds from their source. It is what it is.
–the administrative data stream of care delivery is given to the physician groups as quickly as it arrives in plan systems. Moreover, wherever possible, it is analyzed and prepared for presentation to the line clinicians, to help manage patient care and be stewards of that funding.
–this new kind of payer uses its economies of scale to offer technology tools in clinical care and practice management.
–it uses these economies of scale to develop clinical guidance free of bias introduced by pharma or PBM back-end deals. If their is a bias, it is toward care that makes sense for the line clinician.
–this scale also creates a community of physician organizations operating under similar circumstances. The plan facilitates sharing among these groups.

Information asymmetry and fragmentation of care delivery have been used by intermediaries to exploit the massive flow of funds from society to those who need health care. This practice has been executed so thoroughly that it is unclear whether current practitioners can change. Physician groups have been driven into near learned helplessness.

Re-aligning participants and their contracts (nothing misty and utopian here) around payment and information that drive better care is the secret sauce.

“Capitation of the ’90’s” is exactly what the CPM abhors. If the paper doesn’t make that clear, please help us do a better job of making that clear.
rb

]]> By: Warren Todd http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-11913 Warren Todd Sun, 10 May 2009 05:03:09 +0000 http://e-CareManagement.com/?p=848#comment-11913 CPM? Sound very similar to the physician capitation initative in California in the mid-late 90's. It was a disaster. The docs did not have the capability to manage costs. They lost their shirts. CPM? Sound very similar to the physician capitation initative in California in the mid-late 90’s. It was a disaster. The docs did not have the capability to manage costs. They lost their shirts.

]]> By: Suzanne Dewey http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-13347 Suzanne Dewey Fri, 08 May 2009 15:36:01 +0000 http://e-CareManagement.com/?p=848#comment-13347 <span class="topsy_trackback_comment"><span class="topsy_twitter_username"><span class="topsy_trackback_content">RT @arthurwlane: Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model http://bit.ly/C0qtV</span></span> RT @arthurwlane: Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model http://bit.ly/C0qtV

]]> By: arthurwlane http://e-CareManagement.com/hope-for-primary-care-%e2%80%a6-from-a-payer-a-white-paper-on-the-collaborative-payer-model/comment-page-1/#comment-13348 arthurwlane Fri, 08 May 2009 15:21:57 +0000 http://e-CareManagement.com/?p=848#comment-13348 <span class="topsy_trackback_comment"><span class="topsy_twitter_username"><span class="topsy_trackback_content">Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model http://bit.ly/C0qtV</span></span> Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model http://bit.ly/C0qtV

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