Monday, April 20, 2009

Female Undies and Integrated Delivery Systems: The DMCB Examines the Relationship

In one of its earliest posts, the Disease Management Care Blog questioned all the fawning over integrated delivery systems (IDS’). Yet, much like the female undies at a Tom Jones concert, accolades continue to be hurled at the notion that vertical integration has useful lessons for healthcare reform.

That was on ample display at the recent World Health Care Congress, where multiple speakers used minor variations of the same canned theme over and over and over. So, as a public service, the DMCB took notes and is happy to provide future national conference speakers with this handy template, suitable for index cards, teleprompters and jumbotrons everywhere.....

As (pick one)....

a) Chief Executive Officer,
b) academic with scant face-to-face patient time,
c) someone who slept in a Holiday Inn last night,

I can confidently state that the association between integration and quality is (pick one).....

a) a no brainer,
b) taken for granted,
c) stated so often by me that I’ve come to believe it.

Y’know, when persons see a doctor, there is a 50-50 chance they’ll (pick one)

a) get evidence-based care,
b) result in a physician actually getting paid,
c) obtain a referral to an expensive specialist who actually likes to see patients.

That’s why as someone who (pick one)

a) is paid far more in a year than many of you will see in a lifetime,
b) really REALLY wants a job in the Obama Administration,
c) is wearing a pricy pair of boxers,

my (pick one)

a) evident reasoning,
b) insufferable arrogance,
c) taking others’ word for it

has led me to (pick one)

a) commend,
b) pitch,
c) worry if I can get a flight back home earlier, so I’ll repeat that

integrated delivery systems are the best hope for (pick one)

a) high quality low cost healthcare reform,
b) me getting to speak at other conferences,
c) getting mentioned in the Disease Management Care Blog.

Thankfully, there are a few contrarian souls out there. The DMCB really likes this piece written by Francois de Brantes and Lawton Burns over at the erudite Health Affairs Blog. Noting that the right kind of payment reform should drive the organization of health care systems, he argues that intelligently designed payments for ‘episodes of care’ will lead to coordination by non-physicians, physician-specific cost accounting, teaming, clinical leadership promoting cost effectiveness, supply chain management, continuous quality improvement and better, smarter billing. None of these are the exclusive province of IDS’ and all are possible in other healthcare settings.

Two other points to keep in mind:

1) Many health care policy experts constantly salute the lower-cost and higher-quality countries in Europe as source of healthcare insight for the United States. Note that they do it without IDS’.

2) The difference between ‘integration’ and ‘consolidation’ may ultimately be only cosmetic. The former suggests there is coordination of care, while the latter portends a local monopoly.

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