Wednesday, September 30, 2015

Health Care Co-operatives, Hospital-Physician Collaboratives, Patient Communication and Other Kumbaya Pipe Dreams

ObamaCare was based on these promises : one, it would lower premium costs by $2500 per family by 2016, it would allow you to keep your health plan and your doctor, it would achieve a Kumbaya environment by getting government, hospitals, physicians, patients, and others to cooperate, collaborate, and communicate to improve care.

Kumbaya is a spiritual camp fire song. People with differences join hands and sing the verses of the Kumbaya song to cover up deep-seated disagreements and to pretend to agree for the sake of appearances and social expediency to patch up differences to act in unison.

The problem is Kumbaya doesn’t work very well.

Take health care cooperatives. In 2010, the Obama administration doled out $2.5 billion to form 23 health care cooperatives as alternatives to those evil big insurers. The co-ops were barred from advertising or marketing , supposedly used to excess by insurers at the expense of patient care. Today 21 of the 23 have either collapsed or on the verge of going out of business.
Or take hospital physician collaborative, which go by the names of Accountable Care Organizations and Medical Homes.
These organizations, the government reasoned. By doing away with the greed inherent in fee-for-service care and by offering bundled services covering the continuum of care, would save Medicare money and cause hospitals. primary care doctors, and specialists to work together in a Kumbaya fashion. Physicians would be rewarded with cash incentives for agreeing to be judged for performance, for engaging in improvement activities, and for using meaningful electronic health records.

So far, Kumbaya hasn’t worked out too well. About half the orginal pioneer ACOs have dropped out, and the record of those joining ACOs have a mixed savings record. Never mind. Hospital groups, universities, health departments, doctor associations clinics and others will now receive $685 million to promote collaboration among doctors and other health professionals.

Finally take patient-doctor communication, such as enabling patients to email providers, more physician assistants and nurse practitioners, and medical coaches and aides to help people with chronic disease cope with their illnesses.
Critics complain singing Kumbaya, which sounds noble in theory , hasn’t accumulated enough evidence to prove that how physicians are paid will achieve savings, that more data will improve that elusive concept called quality , that doctors will participate in more time-consuming email communications with patients, without reimbursement, or that American spending on health care, which grew 5.4% in 2014 or a projected 5.3% in 2015 will be reduced.

With ObamaCare, I’m afraid bipartisan or multiparticipants, Kumbaya is a pipe dream, originally defined as a vain hope induced by an opium pipem, but now perhaps by marijuana.

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