Comments on: Pay For Performance… http://www.letstalkhealthcare.org/health-care-costs/pay-for-performance/ Wed, 07 Jan 2009 00:00:04 +0000 http://wordpress.org/?v=2.5.1 By: Joan Endyke http://www.letstalkhealthcare.org/health-care-costs/pay-for-performance/#comment-149 Joan Endyke Sun, 13 May 2007 00:10:39 +0000 http://www.letstalkhealthcare.org/?p=60#comment-149 My idea re: patient/consumer behavior is to shift the incentives more to the consumer. Just as you can get a car insurance discount for a good driving record, or a life insurance discount for optimal health criteria, why not provide a health insurance discount for people willing to take better care of themselves (or perhaps a tax incentive?) A few simple annual measures could be verified in the doctor's office: waist circumference, Chol & BP WNL (controlled by lifestyle or meds), perhaps resting heart rate or BF% (as a measure of routine exercise adherence), non-smoking lifestyle ETC. If a factor was uncontrollable d/t genetic factors, for example some types of hypercholesterolemia, a note from the physcian would drop that score from the total. As a consumer, who chooses to take care of herself, I feel helpless as I watch healthcare rates escalate to a great degree because of others who choose not to take care of themselves. It is an unfair situation and I believe a financial incentive would drive people to change. I read recently about a company that gave financial rewards for weight loss and had great results when in the past other incentives did not work! They were self-insured and significantly lowered their costs. In one of your other topics you discussed a small percent of people with multiple conditions (diabetes and related) consuming a big percent of the healthcare dollar for treatment. Doesn't PREVENTING these conditions in the first place make the most sense? Great blog. Thank you. My idea re: patient/consumer behavior is to shift the incentives more to the consumer. Just as you can get a car insurance discount for a good driving record, or a life insurance discount for optimal health criteria, why not provide a health insurance discount for people willing to take better care of themselves (or perhaps a tax incentive?)
A few simple annual measures could be verified in the doctor’s office: waist circumference, Chol & BP WNL (controlled by lifestyle or meds), perhaps resting heart rate or BF% (as a measure of routine exercise adherence), non-smoking lifestyle ETC. If a factor was uncontrollable d/t genetic factors, for example some types of hypercholesterolemia, a note from the physcian would drop that score from the total.
As a consumer, who chooses to take care of herself, I feel helpless as I watch healthcare rates escalate to a great degree because of others who choose not to take care of themselves. It is an unfair situation and I believe a financial incentive would drive people to change. I read recently about a company that gave financial rewards for weight loss and had great results when in the past other incentives did not work! They were self-insured and significantly lowered their costs. In one of your other topics you discussed a small percent of people with multiple conditions (diabetes and related) consuming a big percent of the healthcare dollar for treatment. Doesn’t PREVENTING these conditions in the first place make the most sense?
Great blog. Thank you.

]]> By: BC http://www.letstalkhealthcare.org/health-care-costs/pay-for-performance/#comment-131 BC Fri, 04 May 2007 01:04:30 +0000 http://www.letstalkhealthcare.org/?p=60#comment-131 That was a very interesting discussion in Boston Magazine. I wonder about the feasibility of the following: Insurers could make it clear to providers that they are getting a lot of pressure from their employer customers to measure performance. They could communicate a strong preference to have the doctors come up with performance metrics that made sense, were fair and could be measured. If they don't, insurers will have no choice but to develop the metrics themselves. With respect to the shortage of primary care doctors, I think this could be addressed, in part, by the spread of retail store based clinics staffed by NP's and PA's. Moreover, perhaps hospitals could buy up primary care practices, organize them into groups of two, four, six or eight doctors each, and spread them around to insure appropriate geographic coverage. Pay them a competitive salary, give them a reasonable patient load so they can spend adequate time with each patient, and accept current reimbursement rates. This probably means, the hospital would operate the primary care segment of its business at a loss deliberately. To make up the difference, insurers could increase reimbursement rates (both case rates and per diem) for inpatient stays and, perhaps, boost reimbursement rates for outpatient services as well. To save money, aggressively go after the huge amount of wasteful and futile treatment that occurs at the end of life by making sure everyone has a living will, DNR orders are honored, and sound medical practice is redefined to apply common sense depending on circumstances. If, at the end of the day, the number of inpatient hospital beds needs to shrink to reflect reduced demand, so be it. That was a very interesting discussion in Boston Magazine. I wonder about the feasibility of the following: Insurers could make it clear to providers that they are getting a lot of pressure from their employer customers to measure performance. They could communicate a strong preference to have the doctors come up with performance metrics that made sense, were fair and could be measured. If they don’t, insurers will have no choice but to develop the metrics themselves.

With respect to the shortage of primary care doctors, I think this could be addressed, in part, by the spread of retail store based clinics staffed by NP’s and PA’s. Moreover, perhaps hospitals could buy up primary care practices, organize them into groups of two, four, six or eight doctors each, and spread them around to insure appropriate geographic coverage. Pay them a competitive salary, give them a reasonable patient load so they can spend adequate time with each patient, and accept current reimbursement rates. This probably means, the hospital would operate the primary care segment of its business at a loss deliberately. To make up the difference, insurers could increase reimbursement rates (both case rates and per diem) for inpatient stays and, perhaps, boost reimbursement rates for outpatient services as well. To save money, aggressively go after the huge amount of wasteful and futile treatment that occurs at the end of life by making sure everyone has a living will, DNR orders are honored, and sound medical practice is redefined to apply common sense depending on circumstances. If, at the end of the day, the number of inpatient hospital beds needs to shrink to reflect reduced demand, so be it.

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