Macro trends in possible healthcare legislation?

Mark Frisse shares his thoughts about some possible macro trends in healthcare legislation and I agree that these are needed and likely.  I especially believe there needs to be more dialog and a closer link between payer intermediaries and decisions at the point of care.  Too many layers and being too far removed increases the risk of undesirable outcomes.

The trends:

1. A shift from plan exclusion of pre-existing illness to controlling expenditures of covered members
2. Rising health care costs
3. More dialog between payer intermediaries and decisions at the point of care
4. More capitation and risk relationships with providers
5. More dynamic provider networks based on a variant of social networks and preferences
6. A shift in the delivery of health care services from physician-based practices to networks of clinicians with varying skills practicing in a wider range of accessible settings
7. A shift in "ROI" from short-term return to long-term value
8. A shifting responsibility from intermediaries to individuals
9. Administrative simplification
10. Pricing and quality transparency

Comments

[Wellescent Health Forums]

For item 7, the question of ROI depends on whose investment is being considered. Patients are interested in long term ROI, but those providing the service will always want short term ROI if it does not erode the long term.

For item 10, I would be interested in seeing the findings around quality transparency. I have not seen much in this respect to date.

[Mark Frisse]

Concerning #7, yes, it certainly depends on whose ROI you are talking about. A lack of transparency on all fronts makes it difficult for consumers to engage. And there's the "moral hazard" issue.

From my perspective, the quality groups - and there seem so many - seem to want to emphasize nearly everything. Can't we make it simpler - focus on a few things - a "version 1.0" and go from there? But certainly things are more coherent than some years back. But basing quality on claims data has limits - like the proverbial drunk looking for his lost keys at the corner. He suspects they are in the alley, but there is insufficient light there!

Thanks

Mark

[thielst]

These are both great comments and I want to take it a little farther.

We are likely to fail if we focus on everything at once unless everyone leaves their individual interests at the door and we start over with a new system. The reality is too many stakeholders want change -- but in only someone else's area of responsibility.

Sustainable performance improvement of our current system requires transparency of all and that we establish priorities and focus on a couple of opportunities at a time -- building on our success.

As I've said in other posts, we can't expect healthcare providers to apply scientific methods for performance improvement and then turn around and pull suspected "improvements" from someone's back pocket for new legislation. We have to all get it right and systematically work through each of the key issues.