Sunday, March 18, 2007

Economist Suggests Changes to our Health Care Delivery System: P4P vs P4V

I posted briefly about Pay-for-Performance (P4P) efforts earlier, describing them as the next step in attempts to reduce health care costs while wrapping it up in a package to make it look like an attempt to improve quality.

I remain skeptical that this is the wrong approach. Insurance company bureaucrats will have us "teaching to the test" in the same way that primary education has gone... and with the same disastrous outcomes, I fear. Kids can answer the questions, but can they think? Do we want doctors who just focus on keeping hemoglobin A1C's down, speeding up the time that you get the first antibiotic during abdominal surgery, and counting up the number of cardiac patients they have on beta-blockers? Will we get lost in the forest, just tending to the trees?

Harvard economist, Michael E. Porter, in last week's JAMA, addresses P4P and broader health care delivery issues in a manner which I find very appealing. It places physicians back at the table, while holding us and others accountable for adding value by collaboratively focusing on patient outcome (not process) to improve patient care while controlling costs. In the article, How Physicians Can Change the Future of Health Care, he describes an approach to competitive, cost-effective health care that places the patient back in the center (isn't that what it's all about?), while teams of health care providers work together in parallel (not serially) to address each patient's needs as a connected team, not as an assembly line product. This is apparently what M.D. Anderson and Mayo have been doing for some time.

Take a look at this article and see what you think. If you can't get access to the whole document, email me at mythreeshrinksATgmailDOTcom, and I could send you a few pertinent paragraphs for educational purposes only (for the purpose of comment and criticism). (Or, get his book.)

1 comment:

Anonymous said...

A brief follow-on about Prof. Porter:

Harvard Graduate School of Business Administration -- not graduate school of economics. Best known for pioneering concept of "competitive advantage." Advises presidents and prime ministers on policy.

As a former health care writer/editor and publisher, I can see gaps in Prof. Porter's thinking, relating to health care.

However -- as a graduate from a national MBA program (UNC-Chapel Hill) -- I know Prof. Porter's reputation to be Nobel-level.

U.S. health care is a near-runaway train that if not slowed down in the short-term, serious economic problems can be 99% guaranteed. Listening to new opinions and new approaches are required at this point.

C.A. Chien, M.B.A.