Insights on Health Reform, Courtesy of Medical Home News

Getting more brainy

To the chagrin of the DMCB spouse, the Disease Management Care Blog serves for free on several editorial boards. In its estimation, it's well worth the time.  It's closer to breaking news, has met interesting colleagues, gets to read interesting manuscripts and has one more excuse to take a pass on sharing in the intensely engaging drama of Downton Abbey.

One such publication is Medical Home News, and the latest edition, thanks to a back-page "Catching Up With...." interview with former Deloitte executive Paul Keckley, did not disappoint. The DMCB has seen Dr. Keckley's smarts in person in several venues and the MHN piece did not disappoint. When he opines, the DMCB thinks.

Among his brainy insights....

The struggle to prove that the medical home saves money continues not only because there are many models serving many populations with many metrics.  In addition, "each prominent medical home promotes its model as uniquely effective."  The DMCB saw how pride of ownership and proprietary business models balkanized the early disease management industry.  PCMH advocates, you've been warned.

In "some form" ACOs will survive.  The road from where-we-are to where-we-need-to-be will need to include skills in managing populations on a "risk basis." If that's true, the DMCB provocatively wonders if that means that that ACO "form" will be some sort of HMO, which was very good at manging populations on a risk basis.  Time will tell.

The three things getting in the way of "value-based" care are 1) operational and infrastructure costs, 2) payer-provider agreement on how savings will be shared and 3) "the regulatory framework in the ACA and future laws that will define fair play in value-based purchasing."  At first glance, thinks the DMCB, makes sense until it ponders the irony of that 3rd one.

"Tranparency about prices means little."  It's all about networks, reference pricing and leveraging them to extract value.  The DMCB cannot disagree and is reminded that's how health care markets really work.

The biggest disappointment in health reform is how disconnected the consumer remains, while the biggest plus has been the advent of data-driven health care.  The DMCB wonders if the biggest disappointment has been the battering of the "big government" brand, while another plus has been the growth of the DMCB readership.  Time, naturally, will tell.

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