The Collaborative Forum

In the healthcare reform debate, hospital pay-for-performance has received plenty of discussion—how it could impact health outcomes, how it could promote efficiency, how it could change care coordination. In 2013, we’ll see the first step toward hospital pay-for-performance: hospitals will have some revenues withheld by Medicare and then returned if they meet specific clinical targets.

According to a new study published in the Journal of Public Library of Science, there are economic and human resource issues that may hinder some hospitals from meeting those pay-for-performance targets. And if that happens, the study’s authors are concerned that funding will be taken away from hospitals that provide care in poor and underserved communities.

The study’s lead author, Jan Blustein, MD, PhD, a New York University professor of health policy and medicine, analogizes hospital pay-for-performance with the “No Child Left Behind“ initiative for education that was started several years ago. In an interview earlier this month with HealthLeaders, Dr. Blustein said, “’One of the problems is we know very little about what helps and what works.’ In education, schools are told to do better—‘but there is no science there.’”

Dr. Blustein goes on in the interview, “’And the same thing is true in healthcare. We know a lot about what works to improve a patient’s health, but we really don’t know about what works to improve organizational performance.’”

And this is where I part ways with Dr. Blustein and her colleagues. Read the rest of this entry →

Vince’s post begs the question: “So…if one were to redesign the MMHD to fulfill the potential for both improving care quality (through access to an appropriate “Medical Home”) while simultaneously reducing healthcare costs, where might we start?”

Vince points us in the right direction in his post, calling our attention to the work of Randall Brown in his report of another CMS demonstration, the Care Coordination Demonstration. Brown points out two key observations:

1. Care Coordination, to save money, must start with the “right” population target; and,

2. Care Coordination interventions can only save money if they don’t COST more than about $120 per participant per month (the amount likely to be saved from a well-designed intervention).

In other words, the solution to the dilemma has two aspects: 1. FOCUS and 2. EXECUTION. Read the rest of this entry →

by Vince Kuraitis, Principal, Better Health Technologies

“Between a rock and a hard place.” Meaning:  In difficulty, faced with a choice between two unsatisfactory options. The Phrase Finder

Before it has even started, the Medicare Medical Home Demonstration (MMHD) is in BIG trouble.

Congress passed legislation authorizing the MMHD in 2006. It is scheduled to begin in January 2010. The MMHD is Medicare’s major test of the Patient Centered Medical Home model being promoted by primary care physicians.

Between the time the MMHD was authorized and now, we’ve learned a lot about what works and what doesn’t work in Medicare care coordination programs. The MMHD is between a rock and a hard place — conflicted by two “must achieve” objectives that are diametrically opposed:

• As a political matter, the MMHD must save money
• As currently structured, the MMHD cannot save money

Let’s look at each half of the dilemma separately.

As A Political Matter, the MMHD Must Save Money

The “Thought Leader’s Corner” in the May 2009 issue of Medical Home News poses a provocative question:

Q: How important will it be for future Medical Home development to be able to show that the Medical Home model generates real, well documented cost savings?

Here are excerpts of how a spectrum of political and health system leaders answered the question: Read the rest of this entry →