Comments on: Beyond The Public Plan Debate: A Pathway To Transform The Delivery System http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/?utm_source=rss&utm_medium=rss&utm_campaign=beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system The Policy Journal of the Health Sphere Thu, 24 May 2012 07:58:29 +0000 hourly 1 By: Health Care. (united health care, universal health care) » Blog Archive » Single-Payer, Public Plans Debated In HA Blog Top 10 http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25787 Health Care. (united health care, universal health care) » Blog Archive » Single-Payer, Public Plans Debated In HA Blog Top 10 Wed, 03 Jun 2009 02:00:05 +0000 http://healthaffairs.org/blog/?p=1166#comment-25787 [...] Beyond The Public Plan Debate: A Pathway To Transform The Delivery System by Harold Luft [...] [...] Beyond The Public Plan Debate: A Pathway To Transform The Delivery System by Harold Luft [...]

]]> By: Single-Payer, Public Plans Debated In HA Blog Top 10 | writteninfo.com http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25740 Single-Payer, Public Plans Debated In HA Blog Top 10 | writteninfo.com Tue, 02 Jun 2009 01:05:46 +0000 http://healthaffairs.org/blog/?p=1166#comment-25740 [...] Beyond The Public Plan Debate: A Pathway To Transform The Delivery System by Harold Luft [...] [...] Beyond The Public Plan Debate: A Pathway To Transform The Delivery System by Harold Luft [...]

]]> By: Health Wonk Review: Bosstown edition « Boston Health News http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25627 Health Wonk Review: Bosstown edition « Boston Health News Thu, 28 May 2009 11:10:35 +0000 http://healthaffairs.org/blog/?p=1166#comment-25627 [...] Affairs Blog, Harold Luft  proposes a risk pool as an alternative to the public plan in "Beyond The Public Plan Debate: A Pathway To Transform The Delivery System.”  Luft discusses the “weaknesses of the competing visions for a public plan option.” He [...] [...] Affairs Blog, Harold Luft  proposes a risk pool as an alternative to the public plan in "Beyond The Public Plan Debate: A Pathway To Transform The Delivery System.”  Luft discusses the “weaknesses of the competing visions for a public plan option.” He [...]

]]> By: Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries « Ted DeCorte @ Eclectic Buzz Blog http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25576 Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries « Ted DeCorte @ Eclectic Buzz Blog Fri, 22 May 2009 19:35:01 +0000 http://healthaffairs.org/blog/?p=1166#comment-25576 [...] Luft on the Health Affairs Blog offers a proposal to work around the shortcomings he sees in public plan options and a national [...] [...] Luft on the Health Affairs Blog offers a proposal to work around the shortcomings he sees in public plan options and a national [...]

]]> By: Hal.Luft http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25572 Hal.Luft Thu, 21 May 2009 13:40:15 +0000 http://healthaffairs.org/blog/?p=1166#comment-25572 My major concern about the broad-based ACO is that efforts to reduce the use of expensive services will require a redistribution of resources WITHIN the group. As you point out, I think this will be difficult, if not impossible. It is true that large integrated systems appear to do this, but I think they have been successful by growing their patient base rapidly and increasing very slowly the number of interventionists and expensive specialists. Thus, while the balance of revenue is different than what we see in the nation as a whole, there's never a "take-away." The notion I'm proposing for the Care Delivery Team is that those practitioners and facilities simply need to focus on doing very well what they're trained to do, and to constantly provide that care with higher quality, fewer complications, and lower cost. The clinicians in the ambulatory settings will focus on how to best manage the chronic illnesses of their patients. In doing so, they will probably reduce the need for the services the CDTs provide. The Major Risk Pool facilitates the transfer over time of funding from the intensive inpatient services (the CDTs) to the ambulatory environment via the Chronic Illness Management payments. By separating the two aspects of care, it facilitates the work that ACOs should do, but will be unlikely to achieve, if we assume they will be fully integrated. My major concern about the broad-based ACO is that efforts to reduce the use of expensive services will require a redistribution of resources WITHIN the group. As you point out, I think this will be difficult, if not impossible. It is true that large integrated systems appear to do this, but I think they have been successful by growing their patient base rapidly and increasing very slowly the number of interventionists and expensive specialists. Thus, while the balance of revenue is different than what we see in the nation as a whole, there’s never a “take-away.”

The notion I’m proposing for the Care Delivery Team is that those practitioners and facilities simply need to focus on doing very well what they’re trained to do, and to constantly provide that care with higher quality, fewer complications, and lower cost. The clinicians in the ambulatory settings will focus on how to best manage the chronic illnesses of their patients. In doing so, they will probably reduce the need for the services the CDTs provide. The Major Risk Pool facilitates the transfer over time of funding from the intensive inpatient services (the CDTs) to the ambulatory environment via the Chronic Illness Management payments. By separating the two aspects of care, it facilitates the work that ACOs should do, but will be unlikely to achieve, if we assume they will be fully integrated.

]]> By: Bradley Flansbaum http://healthaffairs.org/blog/2009/05/20/beyond-the-public-plan-debate-a-pathway-to-transform-the-delivery-system/comment-page-1/#comment-25569 Bradley Flansbaum Wed, 20 May 2009 13:36:30 +0000 http://healthaffairs.org/blog/?p=1166#comment-25569 Dr Luft, In regard to CDTs (and by extension, even ACOs and bundling in general), the decision to "distribute" monies to the participating health care professionals is always "left up to the local system or group." At its face, makes great sense as rationally, this is a nimble and less centralized method of moving the system forward. However, given the same difficulties that led to asymmetry of payment and physician work force imbalance we have today, this is a problem not easily solved. There is no template or gold standard on which to base model, and I fear that a system left to its own devices will only replicate the same power base struggles that are currently present, mainly, proceduralist/specialist dominance modeled on the misaligned RBRVS system we have today. I am certain it is not a matter of if, but when, bundling is certainly coming. However, can you offer some thoughts on how care models--not of the Mayo, Geisinger vintage--can actually pull this off? Without some form of arbitration or mediation involving neutral parties, I am almost certain major inequities will be built into system, further propagating the problems that exist today. While the devil is in the details, these are the huge stumbling blocks folks at the policy level dont address--and as a result, small hospitals and networks will stumble. At that strata of delivery, most professionals are not equipped to make these types of decisions. Thanks Brad NY, NY Dr Luft,
In regard to CDTs (and by extension, even ACOs and bundling in general), the decision to “distribute” monies to the participating health care professionals is always “left up to the local system or group.” At its face, makes great sense as rationally, this is a nimble and less centralized method of moving the system forward.

However, given the same difficulties that led to asymmetry of payment and physician work force imbalance we have today, this is a problem not easily solved. There is no template or gold standard on which to base model, and I fear that a system left to its own devices will only replicate the same power base struggles that are currently present, mainly, proceduralist/specialist dominance modeled on the misaligned RBRVS system we have today.

I am certain it is not a matter of if, but when, bundling is certainly coming. However, can you offer some thoughts on how care models–not of the Mayo, Geisinger vintage–can actually pull this off? Without some form of arbitration or mediation involving neutral parties, I am almost certain major inequities will be built into system, further propagating the problems that exist today.

While the devil is in the details, these are the huge stumbling blocks folks at the policy level dont address–and as a result, small hospitals and networks will stumble. At that strata of delivery, most professionals are not equipped to make these types of decisions.

Thanks
Brad
NY, NY

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