Whether the “Patient Protection and Affordable Care Act” (a.k.a. Obamacare) is upheld or repealed, the undercurrent of change is underway. Not the type of change where government mandated healthcare insurance is overseen by a new regime of government bureaucrats and the tax payers ultimately pay the bill. I am referring to a positive change that is the reengineering of healthcare delivery. If you are thinking this is code for the rationing of healthcare, you’re wrong. It is a fundamental change in the thinking of how healthcare delivery can be improved while reducing costs and making it more affordable. Like any business, decisions are made based upon how we are compensated. As any company wants to drive a business in a strategic direction, they need to align the goals and compensation across an organization. Revision in compensation for healthcare services is one of the catalyst’s that is creating this alignment in rethinking the delivery of healthcare.
Historically the compensation for healthcare providers (hospitals and clinics) and physicians are not in alignment and for good reason. A barrier was created between these parties through legislation with the underlying intent to protect patients by preventing healthcare delivery systems and physicians financially benefit from making patient referrals and healthcare treatment plans driven by financial gain. The objective is to keep the physician unbiased in their decision making of how to plan and deliver the best care for each patient. An unintended consequence of this legislation is that the healthcare delivery system and physicians are not aligned in making the most cost effective decisions and lacked the financial accountability for quality of care issues. Therefore, physicians that drive patient care make decisions regarding clinical treatment without understanding the true cost relative to the clinical outcome compared to lower cost alternatives.
Now that we are on the verge of a crisis, some of these barriers are being temporarily lifted and accepted by the healthcare community to promote alignment between the delivery system and physicians in looking at how to reduce healthcare costs. The irony is that both organizations can benefit financially in making better informed decisions by looking at the true cost of services and determining the best course of action based upon a patient’s clinical condition without sacrificing quality of care for the patient. With the advancement of information technology we can measure and monitor the performance of healthcare delivery systems and physicians to identify those who are the best performers in clinical outcomes while reducing the cost of care. This technology also supports the identification of those that may start down that slippery slope of putting their financial interests before the patient.
A number of projects are now underway to lay the foundation of change in the delivery of healthcare. In upcoming blogs, I will speak about new terms such as Global or Bundled Payments, Accountable Care Organization, Gainsharing, Partial Capitation, Patient-Centered Medical Home, inpatient care warranties and private contracting.
I will also share the pros and cons of each of these proposed changes and what it means to us as a society. One thing you can be sure is that in five to ten years from now the business of healthcare will be different. There are a number of healthcare executives, physicians and clinicians committed to the challenge of improving the affordability, accessibility and quality of healthcare. This is something that affects us all both personally and nationally. I look forward to this journey and embrace the privilege to be a guide. Please feel free to share with me stories and ideas of what works well as we all try to improve the quality of healthcare for our families, neighbors and nation.