Posted 5/09/13 on Medscape Connect’s Care & Cost Blog
On a recent call with a large manufacturer, my company’s team expected to describe how we develop primary care medical homes that become platforms for managing comprehensive health care clinical and financial risk. But the team on the other end of the phone beat us to it. Their remarks – that health care cost is a multi-headed monster that requires a broad array of simultaneously executed approaches – were a breath of fresh air.
They wanted to avoid approaches that don’t work or are designed to accrue to a vendor’s disproportionate financial advantage, and focus instead on mechanisms that measurably improve health and reduce cost. Their conventional current clinic vendor wasn’t onboard, philosophically or in terms of capabilities, and so wasn’t getting results. They were looking for a replacement vendor that could help them drive more appropriate care, with clear rules for patients and providers.
Continue reading “Using Strong Carrots and Sticks To Drive Health Care That Works”
Posted 4/21/13 on Medscape Connect’s Care and Cost Blog
What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are the observations of one industry-watcher who has worked on all sides of health care, but who now spends most his time focused on the interests of those who pay for it. No crystal ball, but several trends are clear.
There are now concrete signs that health care’s purchasers are exhausted and seeking new solutions, that a competitive marketplace is emerging and getting increasing traction. As they abandon ineffective approaches, the paradigm that has dominated the industry for the past 50 years will be upended. The financial pressure felt by buyers will transfer to the supply side health industry that has come to take ever more money for granted.
For decades, fee-for-service payment, inclusive health plan networks, and a lack of quality, safety and cost transparency have been enforced by health industry influence over policy, effectively neutralizing the power of market forces.
Without market pressure, physicians have felt little need to understand their own performance relative to that of their peers. The variation of physician practice patterns within specialties has been high, with some physicians’ “optimizing their revenue opportunities” by veering wildly away from evidence-based practice. Even so, until recently in this dysfunctional environment, it has been nearly impossible to identify high and low performers.
Continue reading “How Physician Practices Can Prepare for a Health Care Marketplace”
Posted 11/28/11 on Health Populi
Walmart issued a Request for Information to expand its retail health footprint in the communities in which the world’s largest company operates. That was a strong sign that retail health has surpassed a tipping point. Now, there are hard data to support this observation from a RAND Corporation research team.
Trends in Retail Clinic Use Among the Commercially Insured, published in the November 25, 2011, issue of The American Journal of Managed Care, quantifies retail clinic utilization among a group of Aetna health plan enrollees between 2007 and 2009. In those two years, use of retail clinics grew 10-fold.
Continue reading “Retail Health is Hot, Especially for the Young, the Affluent, and the Not Particularly Sick”
Posted 10/24/11 on Health Populi.
Walmart is increasing premium sharing costs for employees subscribing to health insurance, and cutting the benefit for part-timers.
Quoted in the New York Times, a company rep said, “over the last few years, we’ve all seen our health care rates increase and it’s probably not a surprise that this year will be no different. We made the difficult decision to raise rates that will affect our associates’ medical costs.” In so doing, Walmart told the Times that they will, “strike a balance between managing costs and providing quality care and coverage.”
Continue reading “Walmart’s Rolls Back Employee Health Insurance: Just Another Employer Facing Higher Health Care Costs?”