Once everyone has health insurance, Dr. Porter says the next steps are to increase value. Start out by measuring and reporting meaningful consumer-friendly outcomes on every provider, doctor and hospital. Wellness and prevention should be covered, preferably as a bundled package of services. Services should be organized around ‘conditions,’ (e.g., heart attack) not around location (e.g., the hospital) and payments should be bundled in a manner that pays for the condition ‘episode.’ Providers that achieve high quality and low cost for their conditions should be rewarded with more business, but not to the point where they achieve monopolies. The electronic health record will support reform, not drive it. In contrast, enabling patients to be better participants in their own care is a critically important part of health reform. New organizations in D.C. will be necessary to regulate all of this.
In addition, while Dr. Porter is all about outcomes, the DMCB isn't too sure that insurers can be necessarily blamed for trumping the denominator function of 'value' [defined as 'outcome/price'] because purchasers want the lowest premium possible. Unfortunately, that can mean coverage denials, cherry picking and consumer cost sharing -- and not being enlightened, having open season enrollment and accepting a high medical loss ratio.
Dr. Porter seems to think of insurers as large utilities or intermediaries that package and deliver services, when what they're all about is transferring risk. That's a definitional problem, not a show stopper.
The DMCB really likes Dr. Porter's recognition that patient-consumers need to become active in managing their own conditions. To celebrate, it had seconds on its lunchtime soup).