One Size Fits Most
This may be a surprise to some of you, but I do not look good in a mu’u mu’u. For those of you who may not know, a mu’u mu’u is a very comfortable, very loose fitting Hawaiian dress that just sort of hangs off the shoulders of the wearer. It is designed to fit almost anyone and to be worn for any situation. And although it may fit over my frame, I certainly do not look good in one.
As I read and follow what’s happening in the healthcare landscape, it seems to me that many people are searching for the mu’u mu’u model for healthcare. What can we design that fits (most) everyone in every situation? And by doing so we have lost sight of the fact that there are very likely multiple solutions to this very complex problem.
Last week Atul Gawande wrote an excellent article in The New Yorker entitled “The Hot Spotters” that asked the question Can we lower healthcare costs by giving the neediest patients better care? His arguments were both persuasive and thought provoking. I do believe, this model may indeed work for certain patient populations – the sickest among us, but will almost certainly not work for the remainder of us. Models such as Qliance in Seattle or Hello Health in New York City provide new and innovative ways of seeing patients and will be great for some, but will not work as well for the patients Dr. Gawande describes.
Much of the discussion and debate on Capitol Hill and around the country is focused on which model will improve quality the most and save the most cost. This equation too frequently circles back around to a model which is driven by the most efficient payer structure or by what will fit into the already existing mammoth infrastructure that exists in healthcare today. As long as we continue to ask the question of which model is best, I fear we will continue to get the same answers. The question we should be asking is how can we best care for very different patients with very different healthcare needs. Before we all get herded blindly into the ACO corral, let’s be certain we are focusing on caring for the needs of patients, not just the need to have a solution.
Nice post. The door to the ACO corral is open and we're already on our way, for better or worse.
Don't need to see you in a mu'u mu'u which, prior to this post, I spelled moo moo.
Bryan, the door to the corral may be open, but with the right leadership not everyone will have to go in. One of my biggest fears is that the momentum around ACO's will stop others from continuing to innovate and investigate new and better care models.
-Mark
Mark, I agree with your comments regarding Atul Gawande's article in the New Yorker. There is no question that if we can intervene earlier in the course of a patient whose health is deteriorating rapidly then we will ultimately save money on the backend.... aside from the obvious health benefits to this patient population.
I also agree with the your contention that it is almost impossible to come up with a one-size-fits-all scenario that will apply to all the diverse patient populations that exist in this country. In addition to Qliance in Seattle or Hello Health in New York City I would also add FairCareMD.com to that list. They are enabling physicians and patients to negotiate directly for care episodes.This platform, if it executes properly, will allow the physician to offer care directly to the patient for a pre-negotiated cost. Because of the payment system utilized the physician will save on the 30% which typically goes to their the billing and collection expenses.... and will be able to pass those savings on to the patients.
Lastly, in the rush to come up to speed and prepare ourselves for the oncoming ACO train which is approaching --- many of the players involved are simply jockeying for position. They realize that in a model where one payment is offered that there will be a so-called winner and a so-called loser. I fear that most of the players involved have lost the view of the forest through the trees and in doing so run the risk of leaving the patient and patient centric care out of the equation entirely.
Wish I were out of NY and in Hawaii right now :-(
Howard
I have to admit a bit of confusion - is an ACO a 'unicorn' - imbued with mythic powers but never actually seen or is it a single well defined entity toward which we are all being 'herded'? My experience as part of the Premier ACO collaborative is that it is more an gigantic 'will 'o the wisp' that generates an equally enormous and ill-defined anxiety. Let us consider the reasons that the defining regulations have been delayed - with so many blind men stroking the elephant could it be that it is too hard to describe? Is it fear of ACOs or fear of the unknown that drives us to huddle together 'round the fire in the dark?