Tuesday, April 22, 2008

Presidential Candidates Healthcare Insights, Medicare's P4P and a Glimpse of Collaborative Care Systems

The Disease Management Care Blog offers some additional reportage on the April 21 World Health Care Congress:

A Panel Discussion involving advisors from the presidential candidates’ camps impressed Kaiser CEO George Halvorson. The DMCB agrees the depth of knowledge and amount of analysis was considerable, especially since each speaker only had ten minutes to speak. There truly was little sound-byte laden posturing. What was remarkable to the DMCB, however, was the novelty of the Republicans. While it appears the Democrats want to expand the current business-government based health insurance model, their opponents want to develop an individual purchase model designed to force market-based competition, possibly backed up by vouchers. Just who is being radical?

Another separate session taught the DMCB that unless Congress steps in with wacky steps to protect its constituent hospitals, we can expect CMS to get really REALLY serious about ‘value-based purchasing.’ They appear to really like the results of their Premier Pilot that hit the trifecta of increased quality, diminished variation and lower cost. Flushed with that success, more preventable conditions are being added to their P4P list. And what about the observation that patient complications and mishaps can occur despite the best of care? Tough, because a) ‘we’re not even close!’ meaning the majority of complications and mishaps are happening because of shoddy care and b) CMS has the statutory authority to go after ‘reasonably preventable’ conditions, not perfectly preventable conditions. In the opinion of the DMCB, CMS is in the hunt for some more badly-needed successes, even if it means using some very blunt tools.

The biggest disappointment was a panel discussion anchored on Clayton Christensen of the Harvard Business School. An intensely intelligent and earnest professor, Dr. Christensen forayed into the virtues of a thoroughly coordinated regional health care system. Maybe, but the DMCB is more excited by jargon that uses “collaborative” instead of “integrated” and “ecosystem” instead of “top-down system.” Silly and na├»ve you say? Maybe, but Boeing doesn’t own much of its manufacturing anymore; it uses a network of outsourced customers that are constantly shifting/improving their processes in an intensely supported IT environment that leads to the planes’ final lower-cost, higher-quality modular assembly. More on the implications of this for a later post.

And an addendum on Deep Dive (see below). If you accept that usual disease management is no better than a placebo/sham intervention or usual care, the lesson of Deep Dive is that the secret sauce of targeted enhanced care management is truly cost-saving compared to usual care.

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