Sunday, February 14, 2010

Some Common Sense Suggestions on Health Reform

In a prior post, the Disease Management Care Blog reviewed Business Week's dour report on disease management. As readers may recall, BW relied on the single anecdotal experience of a dubious General Electric medical director to portray the entire care management industry as a waste of money.

Well, that same General Electric medical director has penned a common sense editorial about health reform in the most recent on-line version of American Journal of Managed Care. It gives good insight on how a commercial non-governmental employer-insurer thinks about insurance reform.

His DMCB-abbreviated short and sweet recommendations follow:

First, everyone has to agree on four assumptions:

1) Reform is a work in progress and rapid cycle assessment of pilot programs is necessary,

2) Provider payment systems need to evolve quickly to being performance based,

3) Not only is all politics local, so is health care

4) Continued flexibility on pursuing quality and cost is important.

Assuming everyone can agree on these, then.....

CMS and the private sector will need to coordinate performance-based payment approaches. Neither alone are likely to get the docs' attention.

Beware the unintended consequence of increased provider coordination that could lead to the formation of local physician-hospital monopolies. Pricing transparency is a minimum requirement and if that fails, CMS and private insurers will need to enforce price ceilings.

That being said, the collective experience of the experimentation described above could act as a national information resource and act as a safe harbor that allows the physicians to focus on clinical quality improvement rather than payment rates.

The DMCB hopes someone points these out at the Feb. 25 White House health reform meeting.

No comments: