Further, giving citizens healthcare premium rewards for evidence of improved health, and penalties for evidence of disregard for health would be a great step forward. Connected health tools enable that vision. However, I don’t see any stomach for this in our politicians, so we will need to work within the current policy framework. Some health plans are making progress in this arena. And just because we don’t have this lever to pull, it does not mean we should abandon the whole concept.
As to the argument that ACOs will not save money, I think we have a chance. At Partners there is a deliberate and sustained effort underway to make us more lean and efficient. I’m sure other providers are going through similar processes. Is it enough? Probably not, but it’s a start and movement in the right direction.
I have to admit that were it not for my near complete agreement with the authors’ prescription for success, I probably would have ignored the piece and moved on. But the thinking articulated in the last half of the editorial is so compelling I had to write about it.
The first answer the authors propose is more use of tools such as retail clinics. Couldn’t agree more. The good news is that it appears this will happen with or without ACOs, because of consumer demand for simpler healthcare that is easy to access. However, some provider organizations, notably the Geisinger Health System, are putting a big investment into the expansion of retail clinics. I look forward to watching their results and in turn watching others adopt.
At the risk of having my telehealth colleagues throw rotten eggs and tomatoes at me, I’m going to suggest that the focus on interstate licensure as a barrier is overblown. If you look at the market share penetration of telehealth and remote monitoring programs within any given state (patients managed in this way divided by total patients managed), I think you’ll see what I mean. There is more than enough opportunity for expansion within a given state. Of course, the ideal system would not be state based, but I don’t see this as a true barrier to telehealth adoption or to success of ACOs.
Last but by no means least is the nod that the authors give to the importance of connected health. Of course, I agree with that! Seriously, if we are going to use our current provider work force to care for the current patient base, plus the millions of new folks coming into the system due to access reform, we will have to expand our tool set beyond the tired old office visit. Work at the Center for Connected Health has been building toward this vision for the last 10 years or so and we’ve managed to demonstrate better outcomes for chronic illness management, better patient engagement, and more efficient use of provider labor all with connected health. In fact, we were quite proud to see our work featured in a recent report from The Commonwealth Fund.
On balance, I congratulate the authors of the WSJ editorial for daring to buck the establishment. And I suspect if we sat down over a cocktail, we’d agree far more than we’d disagree. But in the end, I’m an optimist. I’m also pleased to see how our leadership and our providers are responding to the ACO call here at Partners, so I see greater chances of success than Christensen et al.
Where do you come down on this one?
