Monday, February 10, 2014

"No Outcome No Income," "Bundled Payment is Capitation in Drag" and "Big Data is Big"

The microphone....
The adage "no outcome no income" was first coined by Jefferson's David Nash in March of 2010.  As founding dean of the impressively named "Jefferson School of Population Health" at Philadelphia's Jefferson Medical College, he's supposed to think of stuff like that.

So, when he gets interviewed by Managed Care Magazine, it's worth it for the rest of us to listen for insights and other quotable nostrums.  The Disease Management Care Blog found two others.

Thirty million of our fellow citizens are in some type of bundled payment experiment.  It will take two to five years before we really know how well it works.

It's just a matter of time until a federal agency somewhere is charged with asking about cost-benefit and cost effectiveness ratios.  But, that doesn't mean that Washington DC will decide formulary status of individual drugs for hospitals or insurers. They already know how to decide that.

$750 billion of waste in the U.S. health care system means we have the resources to pay a premium for good clinical outcomes. Look to no-pay for readmissions, sentinel events, central line infections, catheter infection to spread to other clinical domains.

Despite it's bad name, capitation bent the cost curve and there is no evidence, outside of anecdotes, that it led to the systemic withholding of care.  Bundled payment and pay for performance are "capitation in drag" and, to the degree it is capitation, they will also bend the cost curve.

If the promise of "personalized medicine" is fulfilled, we won't need cancer screening.  Goodbye to mammograms?

Population health is based on three pillars: the uneven distribution of health risks in a population, the recognition that most of those risks are social in nature and implementing health policy that can modify those risks.

"Big data is big" because it will increasingly inform payers' ability to achieve clinical and economic value.  Think about asthma program planning based on zip codes.

Electronic health records are not the same as registries.  Rather, these databases need to be grafted on top of the EHR.  And good information that gives good insight will lead to physician buy-in for a changing health care system.

Physicians in "onesie and twosie" medical practices are doomed for many reasons, including an inability to benchmark their performance against the competition.

By the way, Dr. Nash will be emceeing the 14th annual Population Health Colloquium.  The Disease Management Care Blog will be a speaker, which is only further proof of Dr. Nash's perspicacity. The conference starts on March 14, so mark your calendars, find out about registering here and, if you do go, please plan on saying hello!


Bradley Dean Stephan said...

" . . . the recognition that most of those risks are social in nature and implementing health policy that can modify those risks."
I agree with his 2nd pillar that the health risks are social in nature - so, should we not look to social policy for their modification?

John Marcille said...

I agree with the Disease Management Care Blog that Dr. Nash has a lot to say. He is a clear thinker, articulate, and he is hopeful. If you click on the link at the beginning of the DM Blog article, you'll go to an edited transcript of the interview that I and Sonja Sherritze, editor of P&T, did with Dr. Nash. The full video is there as well.

John Marcille
Managed Care