So how do we get from the fee-for-service we have today to the accountable care organization that seems to be the solution for controlling costs and better care? Dr. Patterson suggests a hybrid model to ease the transition between the as-is and to-be state. In this transition state, insurers would agree to a global payment contract with physician groups in each speciality; these groups would be organized on a geographic level. The payment method would occur as follows:
"Payment would be based on insurer-paid claims for that specialty for the enrolled population for the previous year. Primary care would continue to be offered by fee-for-service providers, which would allow patients to retain their current primary care physician."
I'm a little unclear as to how this increases the financial incentives for physician groups, if they are paid basically a lump sum for their treatments. Financial incentives need to be tied to something that physicians have control over, either how much time they spend with their patient or the quality outcomes of their treatment. The difficulty with the later though, I've started to realize, is that a doctor can do everything right and still have a patient that remits. However, maybe in a statistically significant patient population, quality outcomes can be measured by things like hospitalizations, emergency room visits, etc. There needs to be a special task force to find out what these quality measures are and the clinical environment necessary to apply them.
I didn't get this before, but the title refers to bending the cost curve from a steep upward slope to a more gradual or flat cost growth rate.
Act II — Curve Bending
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