From ‘Health Reform’ to ‘Delivery System Transformation’
Well we made it! It’s over for now. Obama thrashed through the red zone and against all odds drove the football of health reform across the plane of the goal line. But no rest for the weary, since that drive was the ‘easy’ part. Congrats Mr. President, the ‘Patient Protection and Affordable Care Act‘ as amended by the ‘Health Care and Education Reconciliation Act of 2010‘ is now U.S. law. Yet, phase two, aka the ‘devil is in the details’ implementation challenge is now before an industry that has historically opted the path of least resistance, rather than risk true game changing innovation.
For an excellent recap and summary of the combined bills, see: Kaiser Family Foundation’s ‘Summary of Coverage Provisions‘. Yet, I am most interested in the quality, and payment provisions that will drive the innovators’ in the mix. Most of the applicable language can be found in ‘The Timeline for Accountable Care: The Rollout of the Payment and Delivery Reform Provisions in the Patient Protection and Affordable Care Act and the Implications for Accountable Care Organizations’.
While the law falls short of what I hoped for (I stood for a robust public option to ‘discipline’ the health plan community, and most certainly favored a ‘Medicare E’ option for the 55-64 demographic), it offers many needed incremental improvements to the U.S. health insurance industry practices, as well as the granular ‘patient’s first’ innovation imperative if the reform effort is to honor it’s coverage goals, and not bankrupt the country.
Bottom line, is we’re entering the era of ‘Managed Care 2.0‘, a do-over or ‘Mulligan’ – if you will. Since the failure of the grand HMO experiment, and subsequent risk ‘push back’ in the mid 90’s when the typical hospital sponsored integrated delivery system (a poorly equipped and improperly motivated first generation risk management vehicle) constituted mainstream efforts to manage care, we’re now hoping this time will be different. But will it? What’s changed to suggest we’ll have a different experience this go round, or are we just doing the same thing over (and over) again expecting different results?
To monitor and re-tweet these discussions, I’ve started a Twitter notebook and associated ‘managed care 2.0’ (#mc20) hashtag to pool tweets. I anticipate a robust discussion in both the blogosphere as well as on twitter, so get ready for a flood of activities on Patient Centered Medical Homes (PCMH), Accountable Care Organizations (ACOs), PHOs versions 2.0, and a re-invigorated IPA community including their Management Services Organizations’ (MSOs) as ‘infrastructure and strategy’ hosts.
Also add to this mix the growing membership (and buzz) into direct practice (boutique, concierge, retainer, etc.) medical models that offer access to basic medical care outside of an insurance or health plan context. This is a space that is likely to witness a clash of definitional interest as to what constitutes a ‘patient centered medical home’ and for what purpose, whether it be as defined by law as an ACO or PCMH vs. a primary care practice that opts out of Medicare or participating with health plans, to service their members as de facto equivalents of medical homes albeit of the ‘unregulated variety’.
May you live in ‘interesting times’ or so goes an ancient Chinese proverb or perhaps curse; and yes we do!
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