Sunday, December 19, 2010

The Disease Management Care Blog Welcomes A New Health Care Trade Association

According to Wikipedia, a "trade association" is a collaborative organization made up of businesses that operate in a similar area of commerce that pool resources aimed at a) public relations (education, advertising and lobbying aimed at influencing public policy) and b) standardization (uniform engineering or technical specifications, criteria, methods, processes, or practices). If form follows function, the December 16 "Innovations Across the Nation in Health Care Delivery" conference was about as trade association as you can get.

The purpose of the day long confab hosted by the folks at Health Affairs was to showcase healthcare organizations "that have innovated at the patient care level, created more highly coordinated patient care systems and improved population health." The showcasing was prominently directed at the leader and staff of the newly established Center for Medicare and Medicaid Innovation (CMMI) who treated the conclave as another one of their many listening sessions.

The Disease Management Care Blog listened in too. Once it got past the enthusiasm, PowerPoints and data, it concluded that much (not all) of the day consisted of reports of strained credibility, generalizability and scalability. The DMCB counted nine presentations relying on unsophisticated "pre-post" methodologies to support their triple aim claims, while four others contrasted their cost savings vs. projected costs of unknown pedigree. Most of the practice settings had unique cultures, economics and leadership styles that would be challenging to export elsewhere. Many also involved a local commitment of financial or organizational resources that seemed out of reach of most provider settings, even with CMMI's $10 billion.

It wasn't until the DMCB made full weekend use of spiritually-based libations to commune with the health service research and policymaking gods that it divined that it was probably the last person in the room to recognize what was really going on. Hidden under the patina of evidence-driven policymaking was a five-fold vision: 1) large not-for-profit provider groups using 2) primary care medical homes in 3) regional care systems driven by 4) an academic government alliance using 5) insurance levers to ultimately control health care. Check out at the videos and the listening will reveal classic "trade associating": a) education really aimed at convincing an already favorably predisposed CMMI coupled with b) an emerging evaluation standard that doesn't include rigorous research methodologies. All that's lacking is name, set of bylaws, a red ribbon ceremony and directors. Perhaps this will make do in the meantime?

While DMCB has been skeptical about CMS' ability to actually "innovate," it likes the "systemizing" of medical practice as well as the reorganization of primary care. The DMCB also knows trade associations are important and that their support by medical journals or government is not unusual. So, it would like to be among the first to welcome the colleagues named in this Agenda to getting the recognition they deserve. May you and yours be blessed with regulatory favoritism and being mentioned in legislation. May the organizations that want to be like you get those 6 or 7 figure grants and thousands of frequent flyer miles earned to and from Dulles-IAD.

In a future post, the DMCB will examine the implications of this in greater detail. It will also cull out the few presentations that had some useful data and insightful lessons for it's colleagues in the population health management community.

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