Health Policy Insights from the Medical Home Summit: Wellness, ACOs

The Opening Ceremony of
The Medical Home Summit

The Population Health Blog is back home after attending the intellectually rewarding Population Health Colloquium and Medical Home Summit.  It was great to reconnect with old colleagues and make new friends.

In no particular order, here are some PHB take-aways:

One representative from household-name health insurer spoke in a lofty plenary session on the merits of keeping patients healthy. While the PHB was inspired by the videos of device-wearing joggers, it all seemed eerily reminiscent of the wacky pharmaceutical company value-propositions from years ago. That's when these companies said that they weren't selling "pills" but "cures."  It remains to be seen if Humana's transition from pooling risk to promoting fitness will lead to a similarly unprofitable ending.

More than one smart policymaker expressed skepticism on-stage about the ability of Accountable Care Organizations to reduce costs or increase quality. Wow. The PHB suspects more ACO shoes are getting ready to drop inside the beltway. If that's correct, it seems the expert-class is not only reducing their exposure to the coming stinkbombs, but is retooling to get in on The Next Big Idea gravy train.

One compelling speaker suggested that truly "patient-centric" primary care medical homes should offer timely access, the ability to talk to the doctor by phone at any time and attentiveness to the social dimensions of their patients' needs while richly rewarding docs to provide high-value care to fewer patients.  When the PHB mused out loud that may be what precisely what Concierge/Direct Primary Care practices are doing, the reaction of the audience prompted momentary concern that it might get lynched. 

The looming repeal of the SGR was mentioned only in passing, suggesting that few believe that this latest legislative fix portends a renewed commitment to health care reform.  As the PHB understands it, the current proposal commits Medicare to a .5% increase in physician fees per year over the next five years. This reminds the PHB of a compromise it made when the Spouse countered that a loaded SUV was a better option than a loaded sedan.  We got the loaded SUV.

And the EHR wasn't mentioned at all, which kept the PHB from offering its novel twist on Ms. Clinton's Emailgate tempest. It's clear that the Secretary reasonably concluded that her State Department's email system was unable to meet her personal workflow electronic communication and documentation needs. Our nation's EHR-using physicians feel her pain and salute her for her approach to finding a workable solution. After the American Medical Association gives her a suitable award, they should ask her if they can expect that same commitment to innovative health information technology solutions when she wins the White House.

Image from Wikipedia
         

Twelve Health Care Predictions for 2014

While the Disease Management Care Blog eschewed forecasting for 2013, it has decided to reverse course and inaugurate the 2014 blogging season with a contrarian duodecimal exercise in futurism.

Will this antidecimal augury align with the mysterious cosmic order and governing perfection?  Let the thousands of DMCB readers (more on that in a future post) be the judge in January 2015......

1. Obamacare will neither succeed nor fail.  This hugely complex law will have too many outcomes, statistics and analyses that will be subject to too much spin by both supporters and detractors. Like puppies clamoring for the mother's attention, the loudest wins, but only in 15 minute media increments.

2. Inflation returns, with a vengeance: While we won't know it until well into 2015 or 2016, 2014 will be the year that the sleeping giant of healthcare costs awakens. Millions of new insureds in an improving economy will finally get their pent-up pricey preference-sensitive health care needs fulfilled.

3. All boats benefit.....While the PHM industry will continue to extol its cost-savings value proposition, its investors will profitably ride the rising tide of overall increased health spending.

4. Duh, it's the delays stupid: While low income Americans will appreciate having access to subsidized health insurance and Medicaid, the middle class' unsubsidized sticker shock will threaten the fall 2014 elections. Caught between conflicting advice of insurance actuaries and political hacks, the White House's regulatory choices will be obvious.

5. Unfavorable prognosis for physician income means an emerging bull market for concierge medicine: Past attempts to replace the SGR never fail to disappoint and 2014 will be no exception. That, however, will only be on the icing on the bitter cake of foregone co-pays and coinsurance by patients who chose all those stinky bronze plans.  As a result, more docs will bail on their insurance contracts and open "concierge" practices.

6. Navigators Ver. 2.0: Knowing that 2014 could be a high water mark for top-line income from newly insured patients, hospitals will step up and hire their own "navigators." Unsurprisingly, they will not seek out the healthy millennials. And insurers, thanks to the "3Rs" that are largely backed by Uncle Sam, won't care about the resulting adverse selection.  

7. Snowden blow-back: as the promise of big-data grows, fearful health care consumers will be even less inclined toward allowing access to their health information.  Too bad they won't be given a say.

8. Innovator's Dilemma for health tech: solutions that are simple, transparent and modular will continue to make 'from the bottom' inroads into a tech industry that - like early data storage - is too complex, opaque and entangled.

9. Speaking of health tech, patient-monitoring solutions that offer more insight and less data will grab market share.  Instead of a series of blood glucose results dumped into an electronic inbox, think algorithms that suggest insulin dose adjustments.

10. Thanks to the battered healthcare.gov brand, conservatives will be better positioned to thwart other "big government" proposals in 2014 outside of health care (for example, education, carbon markets or immigration reform). Progressives will focus on simpler stuff, like increasing the minimum wage and keeping The New York Times afloat, but miss a decades-long setback of Obama-inspired liberalism.

11. ACOs stumble: Far more ACOs will fail than succeed in hitting their risk-share thresholds because docs can't say no, one patient at a time. As a result, we'll see these organizations begin to cut costs by parting company with some of their recently hired physicians, further fueling the concierge medicine movement.

12 Commercial scientific misconduct: Unable to resist the allure of bonus payments (like this) or the branding that is dependent on the public release of quality outcomes, at least one large health entity will be caught committing "reporting fraud."