Monday, March 18, 2013

The Online Healthcare Innovation Forum:  No Guts, No Glory, It Depends on The Story
It’s the same old story, the fight for love and glory.

Lyrics to popular song
With health reform and physicians,  it may not be  the same old story, the fight for the love of your patient,  Marcus Welby style, it may be the glory of being part of an integrated health care organization.
At least,  that’s what I read into a story by Philip Betbeze, in the March 15 Health Leaders Media.  The story, titled “Leaders Reform, Laggards Comply, “ quotes Paul Keckley, executive director of Deloitte Center for Health Solutions.  
In  the story, Keckley says if health executives are to succeed in forming Accountable Care Organizations,   they will have to show guts and determination and place their bets on collaboration with physicians rather than just avoiding penalties for not forming ACOs or not complying with penalties that Obamacare imposes. 
These executives will have to believe that future organizations  will be paid by capitation, bundled fees, and that these organizations will require more primary care physicians, more midlevel  practitioners, and more strategies to enforce collaboration.  They will have to be active rather than passive in committing hospitals and doctors into the collaborative mode.  ACOs, says Keckley, are a race to form lower cost delivery platforms and the organizations who have the guts and determination ot create those organizations.
Keckley may be right,  but there are other races going on. And that is, the race for physicians  to form concierge and other forms of cash only practices, with much lower  overhead costs and with a much more personal relationship with patients. The other race is employers and employess racing to jointhealth savinngs accountable with hihg deductibles and lower premiums rather than staying in HMOs and PPOs.
This is not a phenomenon to be dismissed out of hand.  I was speaking to Jeff Hogan,  an insurance agent in Farmington, Connecticut,  and he tells me 80% of the policies he sells are health savings accounts rather than for  traditional HMOs or PPOs.

 Hogan is not alone.  Today’s March 18  Wall Street Journal reports that  in the new online marketplace,  39% of workers have chosen higher-deductible plans, up from 12% in2012,  while the number choosing HMOs, dropped from 18% to 14%, and those picking PPOs plunged from 70% to 47%.  To save money on premiums, and to set aside money for their future,  workers are willing to take on health-cost riskto opt for cheaper plans, and rely on their own judgment on what  clinical services to pay for.

Tweet:  The race is on to create lower  health care organizations.  These may take the form of ACOs,  HSAs, or cash only practices.



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