Integrated healthcare report最新文献

With health care costs clearly on the rise again, and First Generation Managed Care having matured itself into market gridlock, it is inevitable that there will be a second "employer" revolt. As long as private purchasers do not see organizations fully focused on "value" as they see it, they will not be content with rising costs as "unavoidable". And whereas I do not believe we will see the double digit increases of the 1970's and 80's, consistent annual increases of greater than 5% (or 2-3 times the general inflation rate) will become a major problem, particularly when the current economic expansion ends, and top-line growth in revenues and profits outside the health care sector are once again under pressure. The timing of this second employer revolution is anyone's guess, but it is likely to occur with lightning speed on the heels of a major and sustained correction in the global market. Employers will be looking to move volume to organizations that can offer the best value. Integrated health systems have the potential to become these organizations but, they have significant hurdles to overcome. However, from the private sector point of view, if doctors are willing to listen, learn a new language and become committed to accountability and measurement, employers innately believe that those closest to the "customer" (i.e. patients) are best able to manage. Whether, provider systems can rise to this challenge is unclear. But the stakes, for physicians, purchasers and ultimately patients, have never been higher. And employers, as a group, are hopeful that these organizations can live up to their promise.

In summary, if an organization is thinking of putting together a PSO they should do a thorough due diligence with a focus on their physician interest and competencies. The feasibility needs to be realistic. Some physician organizations we've talked with aren't even considering a PSO. They have too many other fish to fry. Not only that, there is a natural reluctance to dive into a pool without a bottom. Medicare can be counted on to keep changing the rules. Without a set of rules you can count on, why should you engage in the game? It's facinating to watch HCFA staff engaged in their intramural, camp-fire deliberations. They sit around in a circle and ask "what if?" If we reward providers for taking care of sick people, will they simply recruit more sick people? Think about that question for a minute. Isn't there something twisted in this? To be sure, a PSO is not for the naive or faint of heart. To be realistic, budget a minimum of 3 years to break even. If you decide to go ahead with a PSO, the tuition you pay today for the learning curve should benefit you in the years to come. Plan for the best. Prepare for the worst. With opportunity comes risk. Find a visionary to lead this new venture. Only those who see the invisible, can do the impossible.

Why should you take on the risks and complications of developing a PSO? Is it worth it? Will it mean assuming undue risk? The answer to this question gets complicated. This article will introduce more uncertainties than you had before. But, you need to have your eyes wide open. It's not just a question of your capability as a health system or a medical group. It's a question of HCFA's ability to administer the program. Even without knowing the capabilities of HCFA, most organizations would say that they don't trust the government to follow through with any program. In this article by Bruce Fried, we get a rare look at the inner thoughts and gyrations of government, as they attempt to risk-adjust Medicare payments to PSOs and HMOs. In ordinary language, that means, if you happen to have a very sick population of seniors, you will be paid more to take care of them. But, read this and weep.