Monday, May 19, 2008

More on Coordinated Delivery Systems

The Disease Management Care Blog truly appreciates any and all written commentary on prior posts. The best so far is an insightful observation from Anne. She doubts a modular approach to social services has much merit. Unlike the manufacturing of planes or computers, she argues these services can’t be ‘widget-ized’ at several levels. It obscures accountability between the provider and the contractor. Health care providers are not necessary postured to manage administrative and oversight roles. Finally, the modular approach doesn’t have a very good track record; while lead paint in toys is one example, another could be the recent heparin catastrophe.

Anne’s perspective has a lot of merit. However, the DMCB isn’t sure that the current system doesn’t also perpetuate the same lack of accountability. Lapses in care are common among persons with chronic illness and it’s even hard to figure out who the responsible doctor is. Enter the government, employers and insurers who are out to fix the lapses by coordinating care, working with/for the PCP, helping patients choose self care and bringing back versions of capitation with clinical and financial performance guarantees.

What’s more, there are the increasingly complicated benefit designs. While the health care consumer is supposed to be ‘empowered’ by the right combinations of deductables, co-pays and Health Savings Accounts, the DMCB thinks patients could use help to navigate it all. Just because that’s not a traditional role for providers doesn’t mean it couldn’t be achieved. That’s especially true if who is ever paying for the care insists on it and health information technology is tasked to assist this.

As for the lead paint theory, the DMCB has seen clinical outsourcing with performance metrics built right into the contracts. While this kind of patient protection is not necessarily perfect, it’s a heluva lot more accountable than usual medical care, which has its own issues with patient safety.

None of the elements above necessarily depend on a modular approach in a coordinated delivery system. However, the DMCB wonders if government, employers (like Boeing) or health insurers couldn't impose accountability metrics on each contracting entity, perhaps assign one entity with coordinating oversight (maybe to a disease management vendor) and pull the contract(s) if lead paint starts showing up in the product.

The DMCB agrees that the coordinated delivery system is untested has a lot of naïve assumptions built in. That being said, there still may be some merit to the notion. Thanks to Anne for stressing the model.

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