Involve Docs to Maximize Profits

I read this article called Involve Docs in Using Health Data, Expert Tells Health Insurers and just wanted to share my thoughts with you. I actually re-read the title when I first saw it. I thought it said Extort Docs in Using Health Data. I am probably not wrong. Anyway, here are some highlights:

  • “We have the [patient] data; we can look at cohorts, do predictive analytics … to predict where patients are likely to get in trouble and how to engage [them] in a cost-effective way,” Mendelson said Wednesday at a health policy conference sponsored by America’s Health Insurance Plans. “But it’s not enough to have the information; you have to have a connection to physicians who are actually touching the patients … That targeted intervention is really necessary to reap the benefits of the data. Data without intervention is a science experiment.”
  • Having that link with doctors is one reason “why you see plans so engaged in the healthcare delivery system — buying delivery systems, partnering with them, contracting with them, and the like,” he said. “It’s also why you see so much interest in value-based purchasing. When you bring value into the equation and compensate your providers … that’s where you can have that targeted intervention, achieve cost savings, and improve patient care.”
  • Payers have become increasingly interested in value-based purchasing contracts, especially for cost-saving reasons, Mendelson said, citing a survey his firm conducted which found that 74% of respondents listed cost savings as an advantage with value-based contracts. Other advantages lagged well behind — improved patient outcomes was cited by 44%, followed by the contracts’ assurance that the product performs as advertised (41%), and improved relations between payers and manufacturers (24%).
  • But not everyone understands the need for cost savings, he added. “I’ve had many conversations with pharmaceutical executives where they have an idea for a value-based [purchasing] program, but it won’t save the plan any money.” And yet, there are plenty of places where a value-based contract could produce a win for both sides — “cholesterol management is a great one; reducing infections in the hospital [is another],” Mendelson said.

Do not fall for this same trick again. This data only helps the insurers to save money and KEEP IT!!! Never have they passed savings down to anyone. And we have really not seen any benefits from data collecting other than to the people selling it.

Can we just stop pretending otherwise?

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  8 comments for “Involve Docs to Maximize Profits

  1. Peggy J Brown, MD
    March 20, 2019 at 4:41 pm

    I perused that twice and it still does not make sense. To me, it reads like word salad with number croutons.

  2. PW
    March 20, 2019 at 4:35 pm

    I’m glad I read this before I ate my supper, otherwise it would have been on my screen.

  3. Kurt
    March 20, 2019 at 1:54 pm

    I have so many cuss words about this subject I’ll forego belaboring the group. I told my parish priest when I retire in a couple of years, I’m going to need a 3 hour “industrial” confession for all the swear words I’ve used in the last 31 years. Funny thing is whenever I’m away for work for several days, I hardly swear at all. I figure I’ll get all my “swearing sins” off my chest and when retired from primary care medicine, I’ll never have to swear again.

  4. RSW
    March 20, 2019 at 9:12 am

    And this explains what EMRs are all about – collecting the data, and then monitoring and controlling physician behavior for the financial gain of the insurers.

    Physicians will never see a penny of the savings – rather, they will be punished financially if they fail to perform the “targeted interventions.”

    That the AAFP is so mind-boggling stupid as to completely swallow this load of crap is incomprehensible. Are they really that moronic – or are they totally corrupt?

    • Pat
      March 21, 2019 at 11:35 am

      Yes, the AAFP and ABFM are really, totally corrupt.

  5. David Devonis
    March 20, 2019 at 8:51 am

    Doctor Moneyball! Will insurers be able to trade for more productive physicians, or claim them on waivers?

  6. Jennifer Hollywood
    March 20, 2019 at 8:30 am

    PCMH=PROFIT Centered Medical Home. It’s all about the money.

  7. Janis Chester
    March 20, 2019 at 7:47 am

    I heartily recommend reading Big Brother in the Exam Room by Twila Brase. All of your instincts are on the money (no pun intended).

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