Can Payment Reform Deliver on Home Health Care?

On Wednesday, April 13th I attended a healthcare breakfast hosted by Goulston & Storrs to listen to  Andrew Dreyfus, the head of Blue Cross Blue Shield of Massachusetts and a Schwartz Center founder and board member discuss an important question: Can payment reform deliver on the promise of patient-centered care?

 

He started by giving the audience a mini "history" lesson on Medicare and Medicaid.

In 1995, the federal government was proposing significant cuts in Medicare and Medicaid and managed care companies were looking to lower premiums. At the same time national investor-owned companies were entering Massachusetts. “Sound familiar?” Andrew asked the group.  By the way 1995 was the same year that the Schwartz Center was founded.

That same year, Andrew’s best friend, Ken Schwartz – who lay in a bed approaching death at Mass General Hospital – wrote an article for the Boston Globe Magazine in which he asked how compassion in care could be practiced “in a cost conscious world.”

More than 15 years later, Andrew noted, “We are in almost the same place, but this time I believe we have much more reasons to be hopeful.”

“In 1995, the concern was that cost pressures would triumph over compassion,” Andrew said. “Clinicians and patients rebelled, so the constraints were eased or were eliminated, and costs began to increase again.”

Personally (and professionally) my ears perked up when I heard Andrew Dreyfus state: “Healthcare is no longer an individual sport, it’s a team sport – and the patient has to be part of the team,” he said. “We need to design care around the needs of the patient, not around the system’s needs.”

So how is Blue Cross implementing "team sportsmanship into healthcare?" Blue Cross's *Alternative Quality Contract (AQC), pays providers a fixed amount for the care of a patient during a specified time period but holds team members accountable by explicitly connecting payments in order to achieve specific quality goals. Among the over 60 measures used to evaluate quality, are process, outcomes, and patient experience measures – including important elements of compassionate, patient-centered care such as good communication with doctors and nurses, responsiveness of staff, knowledge of the patient, integration of care, access to care, and adequacy of discharge information.

Andrew continued to give the audience real examples on AQC. He quoted a Metrowest doctor he had recently spoke with “I can practice the kind of medicine I want,”  “If chronically ill patients need 45 minutes, I can give them 45 minutes. If my patients just need an email or phone call, I can do that and be paid for it.”

According to Andrew, “We’re watching physicians and patients redesign care together, taking the insurer out of the middle of that equation and putting us on the outside as a support mechanism – we are bringing the patient and caregiver(s) together. Ken Schwartz would have wanted it this way.”

 

 

*Downloaded from content.healthaffairs.org by Health Affairs on January 6, 2011.