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Health plans versus provider organizations in “accountable care”<\/strong><\/p>\n Much of the discussion related to accountable care is led by payers.\u00a0 Undeniably, the role of the payer is critical in that the payer must agree to changes in provider compensation to reward accountable behavior on the part of providers.\u00a0 In our humble view, this is the easy part<\/span><\/em>.\u00a0 Some of the elements of provider payment are indeed complex, including:<\/p>\n However, none of these arrangements actually accrue any value unless provider organizations are able to reduce the costs of care for their “attributed” population.\u00a0 Given that health plans clearly have patients “attributed” to them too, why has health plan success in managing costs has been so muted?<\/p>\n (Authors note: we use the phrase “so muted” here because we have many highly skilled, hard-working colleagues in health plans.\u00a0 We could have substituted “a resounding failure”, but we did not want to discredit the heroic efforts of said colleagues.)<\/p>\n Experience suggests that implementing appropriate economic incentives is necessary but not sufficient to enable accountable care.<\/p>\n The critical value of patient engagement in reducing costs<\/strong><\/p>\n The reason that provider organizations have far more capability to impact the cost of care is twofold:<\/p>\n The latter is particularly important for the high-utilization target populations of interest.\u00a0 Payers often contend (correctly) that they have access to the patient and vice versa.\u00a0 Payers indeed typically maintain call centers to handle inbound service requests, and often maintain programs to assist members in managing disease issues.<\/p>\n But comparing a patient conversation with payer to a conversation with a provider (particularly a physician) is a little like comparing conversations\u00a0 with your telephone company to a conversation with your pastor.\u00a0 They may both be informative, but one is slightly more trusted.<\/p>\n Providers “own” patient engagement<\/strong><\/p>\n Providers (particularly physicians and nurse practitioners\/nurse coordinators) truly are the owners of patient engagement.\u00a0 Individual providers (versus large provider entities) generally are trusted to do what is best for a patient, and are in a position to influence a patient toward behaviors that are more cost-effective.\u00a0 With particular reference to our risk-stratified targeted patients, the engagement steps are:<\/p>\n Some might note that the first three steps have been roughly similar since first practiced by Hippocrates.\u00a0 The new innovations are:<\/p>\n However, if you were thinking that the techniques for patient engagement were more art than science, wait until the next section.<\/p>\n What are “process controls” anyway?\u00a0 <\/strong><\/p>\n Process controls are the techniques used to keep a process on an expected plan.\u00a0 Some people prefer the term “workflow” to process controls.\u00a0 In our view, “workflow” implies a task sequence but does not emphasize the alerts and back-up activities that underpin the compliance with a plan.\u00a0 We believe that the real value of contemporary technology is the capability to use process controls creatively to:<\/p>\n Clearly, the greater the degree of patient engagement, the greater capacity for delegation of tasks onto the patient\/family and the greater need for effective process controls<\/em><\/span>.\u00a0 Delegation of tasks to a patient\/family without structured patient engagement and without effective process controls is the technique Hippocrates used.<\/p>\n Hippocrates left practice before contemporary technology enabled effective process controls (and many contemporary physicians are debating the same career choice).\u00a0 But to discuss the use of technology, we have to move to the the “Virtualize Access” discussion here:<\/p>\n\n
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