He has three keys to make changes in the health care system

1) Accountability — Everyone needs to account for their performance, and feel that they’re accountable for where their dollars flow. And they find that 25% of their employees are going to the top performing systems. Think that they should put incentives into benefit design.

So you should a) share data in a public forum, which forces organization to improve. b) develop health information exchanges with clinical data in them (claims are not enough) which is why B2E does so much chart extract, and is encouraging IT adoption, and c) measuring how well internal medicine works.

2) Better payment models; need a better model—currently wasting a huge amount of resources and getting a mediocre results. They believe that bonuses through shared savings gives a counter incentive to FFS. He thinks docs should be paid with a bonus on top of salary. So B2E is experimenting with 5–10% physician revenue as an incentive (below 5% is not meaningful). Incentives need to be meaningful enough to drive the majority. Plus needs independent review — accountability starts with self-awareness.

The result is that physicians adopt the B2E program are inclined to join in if the incentives are bigger, and now BTE is showing that episode of care costs are lower with recognized docs in the program versus the others…because they have better processes.

Process is important, but you need clinical measures too.  Just knowing that a lipid test was done is not enough. Need also to know what the result was! Because not everyone reacts to the test.  So claims data isn’t enough.

Finally they are trying to develop a new payments system called PROMETHEUS, which is basically evidence based case rates (severity adjusted) with a withhold

3) Consumer activation—they must be incented too, to do the right thing and do self-care and DM, etc and take the right meds….must be told to do so. He wants to charge smokers more, and thinks health plans should all do that. Need to send the message that adding risks to your self will add financial consequences to themselves. Part of that activation is linking individual consumer level that’s relevant to them which he thinks is the physician. How does my guy do?

One last thought: Given that he’s trying to eventually drive costs out of the health care system, and that GE thinks it’s going to make even more money out of health care in the future, how long will it be until Jeff Immelt notices and has him fed to the sharks?