Wednesday, October 28, 2009
More on the Medicare Pilots: The Medical Home Purchasing Cartel That Includes Medicare
What percent of the revenue or the patients is enough to get a hospital's or a physician's attention? In it's prior life in not-for-profit managed care, the Disease Management Care Blog was stymied by only 'owning' a low percent of the patients in many of the provider settings. As a result, even if there were important quality initiatives backed-up by serious money or free assistance (usually in the form of care management nurses), the lack of critical mass compared to other payers hampered our ability to get anything done.
Which is why the Vermont CMS Demo i.e. pilot on involving a multi-payer collaborative in support of the medical home, is so important. By having the all the key purchasers of medical services form a medical home cartel i.e., monopsony, the providers will have to pay attention. The providers will also 'win' by having to operationally deal with single set of processes and payment mechanisms. Last but not least, Medicare (ironically) will be kept honest, because it will have to adapt some of its operations to mirror those of the other more experienced payors. Think tipping point leading to a virtuous cycle.
That's also called synergy, which is why a multi-stakeholder pilot - assuming CMS can collaborate - will be far more likely to show positive outcomes that a single Medicare demo.