Now that Amazon and its partners JP Morgan Chase and Berkshire Hathaway have decided to tackle healthcare for their employees, everyone is tossing out ideas for what they might do to solve the system’s myriad problems. I count myself among those lobbing in suggestions, with my emphasis on making the system more patient-oriented.
Two letter writers in the Wall Street Journal have interesting ideas about what the partnership should do, but ultimately they are misguided.
Fred Hyde, MD, JD, MBA thinks the team should take advantage of association health plan (AHP) rules to beat up providers over pricing, pointing the finger at “monopoly pricing by larger health systems” and prescribing reference pricing or a Dutch auction for the procurement of hospital care. He points to ERISA as a great liberator for larger companies and thinks AHPs could be the answer for smaller businesses.
Well, all three partners already can take advantage of ERISA and that hasn’t really helped them. There’s also no particular reason to think providers are going to give the companies lower prices just for the heck of it.
Robert E. Mittelstaedt Jr., Emeritus Dean from Arizona State University, thinks full price transparency is going to be the answer, “forcing patients to make economic decisions” and pushing government to allow providers to compete on price. In my experience providers don’t want to compete on price and sick patients and their families are not well positioned to shop for most healthcare, especially the expensive and emergency stuff like cancer treatment and trauma care.
The writer says the partnership is “no different” than the history of Kaiser Permanente. In that case why not have all employees join Kaiser? After all there is already Kaiser Permanente Washington, based near Amazon’s headquarters, the former Group Health Cooperative. These plans are no panacea.
I’ve heard people quip that the best thing this group of companies could do for their employees is advocate for a single payer system in the US. I think they can do better than that, but it’s actually a better idea than a lot of what’s being discussed.
The announcement that Amazon will work with JP Morgan Chase and Berkshire Hathaway to create a new healthcare organization for employees has health plans and providers running scared. Initial press coverage has focused on the impact of this group on the market value of CVS, United Healthcare and the like –but how many people really care about that?
CareCentrix CEO John Driscoll has the right idea when he suggests that Amazon should compel provider organizations to put the patient first –for real, not just rhetorically. His three specific suggestions are good ones: mandate self-service scheduling, introduce a universal patient portal, and improve the quality of provider reviews. As simple and straightforward as those sound, they would require Amazon and its partners to overcome serious resistance. It will be fascinating to watch what happens.
Assuming Amazon can make those basic but challenging changes come to pass, I have two additional, ambitious suggestions to help patients:
Ensure that patients receive clear, consistent, actionable follow-up information when they leave a doctor’s appointment or are discharged from the hospital.
Use the full set of information available about a patient to anticipate their needs and help them navigate the system.
The first idea is a simple one, which should be happening anyway, and occasionally does. The challenge is to get the provider system to care enough about what happens upon discharge and provide the tools, training, information and support to enable more seamless and empowering transitions. I was shocked at how poor the discharge instructions were after my release from the emergency department a few months ago, after I was struck by a car. I received basically nothing and had to count on family and clients in the medical system to help me. I know I’m not the only one who’s had this experience.
The second idea is broader and vaguer, but starts to draw on the expertise of Amazon’s partners who are in the financial services and insurance industries and have a lot of information about their customers. The consortium could help patients chart their financial path through the healthcare system, helping them identify what insurance to select, how much to save in their HSA and FSA, and where and when to get their care. It could be a virtual concierge for patients, relying big data and machine learning to provide insights and continuous improvement.
If these suggestions were implemented they would have a high impact, even though they would not completely transform the system. It seems like about the right level for this group to shoot for. If they try to be bolder they will likely fail.
In this month’s always entertaining and occasionally informative episode of #CareTalk, CareCentrix CEO John Driscoll and I discuss the newly appointed Secretary of HHS, Alex Azar, and how he will impact the healthcare industry.
(0:20) With Alex Azar confirmed as the new Secretary of HHS, what are we in for?
(1:25) Will Alex Azar help get drug prices under control?
(3:11) How much of an impact can value-based payment make on healthcare?
(5:41) What needs to be done about the convoluted way money flows through the pharmaceutical industry?
(7:32) Is 2018 the year that we turn the corner on the opioid crisis?
(8:06) Congress reauthorized children’s health for another six years. Can we expect more bipartisan support in the near future?
(8:47) When are we going to see the payoff from health information technology?
Obamacare appears to be under unrelenting attack, yet the law’s push toward value based payments seems to be alive and reasonably well. The Center for Medicare & Medicaid Innovation, which was established under Obamacare, has just announced a new episode payment model, called BPCI Advanced.
In this podcast interview, Archway Health CEO Dave Terry talks about the evolution of value based payments, and makes the surprising assertion that voluntary programs may ultimately be more successful in transforming our healthcare system than mandatory ones.
(0:11) What is value based care?
(1:17) When people think about value based payment, usually they think about ACOs. What else is there?
(2:15) How are these models evolving?
(4:26) Having fewer metrics sounds great. But do the remaining metrics need to be more complex or measured more precisely?
(6:18) What’s the connection between value based care and the Affordable Care Act?
(8:17) The new program is voluntary, whereas under Obama we were moving toward mandatory programs. What are the implications?
(10:18) What is BPCI Advanced? What do providers need to know about it?
(12:52) Say more about post acute care. Why can’t post acute providers be episode initiators?
(14:17) Explain how DRGs could go from hospital-only to global?
(14:50) How is Archway involved in BPCI Advanced?
(16:55) Medicare is the driver, but what is the role of commercial payers?