Ben. First a clarification. You wrote that you avoid lemon dropping by punishing plans that enroll sicker patients. I think you meant to say “rewarding” as that would avoid the dropping.
In the last paragraph you mention a holy grail - Integrating primary care, specialty care, outpatient care, and inpatient care into a cohesive, well-coordinated, evidence-based, and high-quality experience - there you kind of described Kaiser Permanente. We don’t have to ask for PA on an individual doc basis so that’s our advantage over MA (punny). There is a hypothetical concern even on systems like KP because as you say - who are we driving value for - the patient, the doc, the payor (who may not fully be the patient) or the administrator/insurance company. Great job in explaining it all!
Thanks for your response. Yes, lemon dropping would be avoided by proper risk-stratification methods (if they can do it for MA, they can do it for doctors).
KP certainly has its advantages as arguably the most integrated healthcare system in the US. It is not without its critics and controversies as you know. Then again, who in healthcare is?
Great piece Ben. Capitation only gets you so far. Incentivizing the outcomes that are associated with better health and lower costs with additional bonus payments could help. For example, preventative care that keeps patients out of the hospital for problems like heart and kidney failure. Hospitalizations are typically the biggest cost. It’s hard work for sure but so is the messy system we now have. Pick your hard as I’ve heard said recently.
Ben. First a clarification. You wrote that you avoid lemon dropping by punishing plans that enroll sicker patients. I think you meant to say “rewarding” as that would avoid the dropping.
In the last paragraph you mention a holy grail - Integrating primary care, specialty care, outpatient care, and inpatient care into a cohesive, well-coordinated, evidence-based, and high-quality experience - there you kind of described Kaiser Permanente. We don’t have to ask for PA on an individual doc basis so that’s our advantage over MA (punny). There is a hypothetical concern even on systems like KP because as you say - who are we driving value for - the patient, the doc, the payor (who may not fully be the patient) or the administrator/insurance company. Great job in explaining it all!
Ron,
Thanks for your response. Yes, lemon dropping would be avoided by proper risk-stratification methods (if they can do it for MA, they can do it for doctors).
KP certainly has its advantages as arguably the most integrated healthcare system in the US. It is not without its critics and controversies as you know. Then again, who in healthcare is?
Great piece Ben. Capitation only gets you so far. Incentivizing the outcomes that are associated with better health and lower costs with additional bonus payments could help. For example, preventative care that keeps patients out of the hospital for problems like heart and kidney failure. Hospitalizations are typically the biggest cost. It’s hard work for sure but so is the messy system we now have. Pick your hard as I’ve heard said recently.
As usual, an incredibly incisive, thoughtful and provocative essay by Dr. Ben. Awesome.