Earlier this month, the Special Commission on the Health Care Payment System recommended that the Commonwealth move to a global payment system. The recommendation has given us all reason to step back and imagine how health care might look different than it does in today’s fee-for-service world.
Our current fee-for-service system imposes an artificial, anarchistic structure on the relationship between doctors and patients. In that artificial structure, care must happen in the office. Coordinating treatment among multiple clinicians does not count as care. E-mail, in most cases, does not count as care. Specialty care is worth more than primary care. Treating disease is worth more than preventing it. Intensive procedures and high-tech care are worth more than a conversation between a doctor and a patient. And on and on until good care often is being delivered in spite of, rather than because of, the health care system.
Under global payment, this artificial structure is gone. We are hearing from the physicians and hospitals in our new Alternative Quality Contract that the global payment has liberated them from the fee schedule and all its unintended consequences. Under global payment, they are free to deliver care in the ways that work best for patients and their doctors.
Dr. Barbara Spivak, president of the physician group affiliated with Mt. Auburn Hospital, says “our community case managers monitor whether patients are getting recommended care such as colonoscopies for patients over 50, and whether their asthma or diabetes is under control. Very frail patients may have home visits from a nurse practitioner or receive regular phone calls. Fee-for-service would not reimburse us for any of this.”
Atrius Health CEO Dr. Gene Lindsey notes that “much of what is most important to patient health occurs in the home, the workplace, the community, the restaurants where people eat – all the places where we make decisions that protect us from, or put us at risk for, chronic conditions, injury, and infectious disease. With global payment, we can fund the Web portals, text messaging, phone calls, and ancillary personnel necessary to ‘be with’ the patient where life is actually being lived, in the ‘space between the visits.’”
Meeting patients where they live, with the care they need. And a payment system that supports, rather than impedes, that goal. Imagine that.
Andrew Dreyfus is Executive Vice President for Health Care Services at Blue Cross Blue Shield of Massachusetts and former President of the Blue Cross Blue Shield of Massachusetts Foundation.
“Imagine” this: That Blue Cross and Blue Shield cares more about their market share and and their profit margins than they care about meaningful health reform. Of course the Massachusetts BCBS has to call their significant profits “surplus” because they enjoy the legal status of being a taxpayer subsidized not-for-profit public charity. “Imagine” that.
Investigative reporting is long overdue into the business model of BCBS MA’s supposed “not-for-profit” status. BCBS MA paid its past outgoing CEO William VanFaasen a $20Mil golden parachute a few years back as a reward for sheparding through the “landmark” individual mandate insurance law in the state.
The individual mandate insurance law that forces people to purchase expensive private insurance under threat of tax fines is now being used as a model for national reform. The National BCBS Federation is aggressively supporting the individual mandate feature. “Imagine” that.
BCBS MA pays its current CEO Cleve Killingsworth over $3Mil a year. To head up a not-for-profit public charity that is heavily subsidized by Massachusetts taxpayers. BCBS Executive VP Andrew Dreyfus is paid a very handsome sum for his “health care” work, too, we can all be assured. Andrew Dreyfus is also on the national board of directors of BCBS. The national BCBS entity includes for-profits and not-for-profits (source: http://resources.bnet.com/topic/blue+cross+blue+shield.html then click under “Executive Profiles” where you’ll see BCBS MA CEO Cleve Killingsworth listed, too).
“Imagine” that.
What matters is who “owns” this so-called non-profit? The community or a for-profit BCBS? If the latter, the non-profit arm can stay non profitable by “paying to” the for-profit over generous “management fees” which can then be divvied up amongst the executives. So the management fees come from patient premiums and reward the executives and politicians. Don’t forget that they get a piece of the action. THAT is our problem.
very great site.
[...] BCBSMA, we are working with physicians in our alternative quality contract to provide detailed, specific analyses of our claims data that will help these caregivers ask [...]