By John Ballard
When the president appointed Dr. Berwick to head CMS, cries of socialist, communist and worse foamed up from ignorant critics.
Yesterday Dr. Berwick appointed the boss of the newly formed CMI
Richard Gilfillan, MD, will be the new Acting Director of the new Center for Medicare and Medicaid Innovation (�CMI,� or �Innovation Center�) at the Centers for Medicare and Medicaid Services (CMS), CMS Administrator Don Berwick announced today. Gilfillan currently directs CMS� performance-based payment policy staff.
Bureaucrat? Political appointee? Lobbyist? Closet Socialist?
Guess again. This guy is picked from the cream of the capitalist crop, a physician who went to work with the private sector and rose to the top working with private health care organizations and insurance companies.
Before joining CMS, Gilfillan was a consultant for Geisinger Consulting Services, where, Berwick wrote, �he provided consulting services to health care systems and payer organizations regarding the design and implementation of innovative care delivery and financing programs including accountable care organizations, patient-centered medical homes and bundled payment systems.�
From 2005 to 2009, Gilfillan was president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System, a large integrated health system with 750 physicians, three hospitals, and 12,000 employees. There, Berwick wrote, �he helped design a bundled payment, episode of care reimbursement system, ProvenCare, for acute surgical and medical care that rewards providers for providing high quality outcomes. He also directed the development of Geisinger�s ProvenHealth Navigator medical home model and was a member of Geisinger�s CMS Physician Group Practice Demonstration Project team.� Some of the articles Health Affairs has published regarding the Innovation Center and Geisinger are listed at the end of this post.
He doesn't sound like a very good Socialist to me.
He does sound like someone with first-hand familiarity with one of the best-run private sector health care organizations in the country (Geisinger) because he was instrumental in shaping the administrative architecture of that group.
(My first chosen title for this post was "Attention Red-Baiters...STFU!"
I changed it to something more tame but I still feel the same way.)
We are not yet into the third year of the Obama presidency and already positive steps are being taken to find innovative ways to change how health care is done in America. Unfortunately, as Medical Home models and other Accoountable Care Organizations rise in favor with Medicare as reflected in improved payments (at the expense of the Fee for Service model) we can expect grumbling to get louder with professionals and groups thus affected.
More doctors are telling their patients they will no longer accept Medicare patients but this is not a new phenomenon. The only thing that has changed is that new payment models are changing to reward those practices that deliver good outcomes at lower rates. Most of them don't realize it so far, but not since the advent of the Blues in the Fiftes have medical professionals had as much control over how tax dollars are managed in payment for hospital and professional services.
At long last we are moving in the direction of managed competition. In lieu of a single payer model, that's the best we can expect from an economic system that puts profits ahead of all other values. Again this is nothing new. Anyone looking into the history of managed competition in the delivery of health care will eventually learn about Alain Enthoven, "father of managed competition."
Readers looking for more information can download a 25 page document here Note the date, 1993!
Managed competition in health care is an idea that has evolved over two decades of research and refinement. It is defined as a purchasing strategy to obtain maximum value for consumers and employers, using rules for competition derived from microeconomic principles. A sponsor (either an employer, a governmental entity, or a purchasing cooperative), acting on behalf of a large group of subscribers, structures and adjusts the market to overcome attempts by insurers to avoid price competition. The sponsor establishes rules of equity, selects participating plans, manages the enrollment process, creates price-elastic demand, and manages risk selection. Managed competition is based on comprehensive care organizations that integrate financing and delivery. Prospects for its success are based on the success and potential of a number of high-quality, cost-effective, organized systems of care already in existence, especially prepaid group practices. As it is outlined here, managed competition as a means to reform the U.S. health care system is compatible with Americans' preferences for pluralism, individual choice and responsibility, and universal coverage.
?Note also that part about insurers aiming to avoid price competition.
Wonder why.....?
Could it be cuz the insurer -- like all other brokers and sales agents -- is compensated according to a percentage of the transactions??
Competition makes thier cut go down, not up.
This is not rocket science, you know.
Speaking to the point about doctors not taking Medicare patients, it not new, as you said.
ReplyDeleteMore than 10 years ago, my company did a project about health care in Pennsylvania. I had literally dozens of doctors tell me that they had stopped, or were going to stop, taking Medicare patients. They said they lost money on them because reimbursement rates were so low.
They said the only ones making money were the Medicare mills that specialized in Medicare patients. 50 people in a waiting room for a one o'clock appointment was comman, with very little time spent with any patient.
"Medicare/Medicaid mills" usually refers to scams submitting false claims for non-existent equipment and/or treatments, but there may be crowded places places such as "they said" were around. The financial train wreck that is health care in America likely has both.
ReplyDeleteThe simple reality is that if costs don't go down and outcomes up -- and soon -- the next bubble will be the collapse of our medical-industrial-drug-&-disease-management complex. Think of that hundred year old levee in Wisconsin stressed to the limit. It will make the financial collapse look like a summer shower.
Bundled payments (medical home, ACO's), better professional accountability (uniform best practices) and improved outcomes (evidence-based medicine) are no longer optional. We aren't discussing experimental trials. These are already proven practices that have been in operation for decades in a few (too few) of the best health care delivery systems in the country. The time is way past due when these models of excellent care be replicated throughout the country.
The wealthy still be have enough money to keep concierge practices and Cadillac group plans in business. But for the swelling numbers on Medicare and Medicaid the arithmetic simply no longer works.
check your facts... I believe that Dr. Gilfillan borrowed the idea for ProvenCare from his former employer, IBC. Rick is all about the bottom line and not necessarily about quality care. He is certainly using his Wharton MBA and not his MD when making decisions that affect our health.
ReplyDeleteAs a former executive with Geisinger I'm certain he has sterling business credentials and yes, that outfit is managed care and keeps a close watch on the bottom line. It's about time a card-carrying businessman was put in charge of Medicare and Medicaid disbursements instead of yet another political type. Doctors who are also good businessmen are few and far between. (We have a few doctors in Congress, you know, and they aren't all wearing stethoscopes either.)
ReplyDeleteRegarding "...not necessarily about quality health care" if you can support that allegation with examples this would be a good place to furnish links. It is my understanding that improved outcomes, supported by closely tracked numbers, are now part of the compensation reward schedules for accountable care organizations. Improved outcomes is by definition "quality health care" in my book. Yes, I know all about damn lies and statistics, but if the marketing of redundant or completely unnecessary tests, prescriptions and devices is not curbed the current financial train wreck will never get cleaned up. And yes, again, that is about the bottom line. Tax money, you know. I hear cutting spending is all in fashion.