Comments on: Jack Wennberg & The Dartmouth Atlas Project http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/ Sat, 22 Nov 2008 06:43:46 +0000 http://wordpress.org/?v=2.5.1 By: Charlie Baker http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5280 Charlie Baker Thu, 10 Apr 2008 18:50:23 +0000 http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5280 Leanne - Thanks for writing. I do think it's difficult for health plans (the bad guys) to influence the provider community (the good guys) to change - based on this, or any other data. My own view on this - which I kind of stated above - is that this falls into the "heal thyself" category for the provider community. No one disputes there's variation, and I doubt most people in the medical community would even dispute the notion that more care doesn't mean higher quality. Nonetheless, we - the payors - have limited capacity to change this. This has to come from within the provider community. Barry - the best example I know of that follows the path you outline above is the MA Group Insurance Commission, which provides health insurance to about 250,000 state employees and retirees and their families. The health plans that do business with the GIC have to use tiered networks, based on cost and quality. We manage one of the plans that's offered through the GIC, and it's a tiered network plan that tiers specialists. Primary care providers are all first tier, and then select groups of physicians are tiered (one, two and three) based on cost and quality measures. The GIC approach has been in place for three years, and seems to be making some headway. It will be interesting to see what happens when folks like us start making this product available to the rest of the employer community in MA - which for us, will be true on July 1st, 2008, and January 1st, 2009. Leanne - Thanks for writing. I do think it’s difficult for health plans (the bad guys) to influence the provider community (the good guys) to change - based on this, or any other data. My own view on this - which I kind of stated above - is that this falls into the “heal thyself” category for the provider community. No one disputes there’s variation, and I doubt most people in the medical community would even dispute the notion that more care doesn’t mean higher quality. Nonetheless, we - the payors - have limited capacity to change this. This has to come from within the provider community.

Barry - the best example I know of that follows the path you outline above is the MA Group Insurance Commission, which provides health insurance to about 250,000 state employees and retirees and their families. The health plans that do business with the GIC have to use tiered networks, based on cost and quality. We manage one of the plans that’s offered through the GIC, and it’s a tiered network plan that tiers specialists. Primary care providers are all first tier, and then select groups of physicians are tiered (one, two and three) based on cost and quality measures. The GIC approach has been in place for three years, and seems to be making some headway.

It will be interesting to see what happens when folks like us start making this product available to the rest of the employer community in MA - which for us, will be true on July 1st, 2008, and January 1st, 2009.

]]> By: Barry Carol http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5278 Barry Carol Wed, 09 Apr 2008 00:30:47 +0000 http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5278 I don't understand why CMS and/or private insurers have not done more to change the incentives in the system. For example, why isn't there more publicity identifying which specific hospitals (and perhaps doctors) are high utilizers (by national as opposed to local or regional standards) and which are not? Why can't doctors and hospitals be grouped into tiers (like drugs are now) with those who earn a spot in the preferred tier either paid a premium or charge the patient a lower copay? Perhaps the most egregious high utilizers should even be eliminated from the network altogether. So far, it looks to me like hospitals and doctors do not suffer any adverse consequences for high utilization. Indeed, it is more profitable for them to practice that way. Incentives matter. It's not rocket science. I don’t understand why CMS and/or private insurers have not done more to change the incentives in the system. For example, why isn’t there more publicity identifying which specific hospitals (and perhaps doctors) are high utilizers (by national as opposed to local or regional standards) and which are not? Why can’t doctors and hospitals be grouped into tiers (like drugs are now) with those who earn a spot in the preferred tier either paid a premium or charge the patient a lower copay? Perhaps the most egregious high utilizers should even be eliminated from the network altogether. So far, it looks to me like hospitals and doctors do not suffer any adverse consequences for high utilization. Indeed, it is more profitable for them to practice that way. Incentives matter. It’s not rocket science.

]]> By: leanne berge http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5268 leanne berge Tue, 08 Apr 2008 00:40:37 +0000 http://www.letstalkhealthcare.org/health-care-costs/jack-wennberg-the-dartmouth-atlas-project/#comment-5268 I was glad to see the new Dartmouth study motivated you to speak to your blog audience after periods of relative quiet. I also think it's a terrible shame that this dramatic evidence seems to always fall on deaf ears. I believe however that even if doctors were moved by this data - and typically, they aren't even aware of its existence - they still wouldn't know what to do about it. Its not within the hands of individual practitioners to change the supply-side economics but rather more in the control of the policy-makers and others who more directly impact market conditions, including, of course, private influential business leaders like you. I was glad to see the new Dartmouth study motivated you to speak to your blog audience after periods of relative quiet. I also think it’s a terrible shame that this dramatic evidence seems to always fall on deaf ears. I believe however that even if doctors were moved by this data - and typically, they aren’t even aware of its existence - they still wouldn’t know what to do about it. Its not within the hands of individual practitioners to change the supply-side economics but rather more in the control of the policy-makers and others who more directly impact market conditions, including, of course, private influential business leaders like you.

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