POLICY/THE INDUSTRY: Klepper is still an optimist

Nice short video from Brian Klepper on P4P. I think he’s optimistic, in that he thinks employers and the government will impose P4P on

providers. On the other hand the leading proponent of P4P in the government just quit! Then again Brian’s talking about slamming on the brakes or driving over the cliff, so maybe he’s a pessimist.

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  1. Many changes are necessary for solving the healthcare crisis, including the focus on a process of continuous quality improvement — ever-better healthcare safety, effectiveness, efficiency, affordability, timeliness, and availability — driven by the acquisition and use of evolving evidence-based knowledge in a high-fidelity healthcare system. Such a transformed system would enable providers to give patients/consumers the precise interventions/services they need when they need them, with minimal cost and risk, and recommends nineteen tactics for healthcare reform, including:
    • Interdisciplinary collaboration
    • Implementation of evolving evidence-based guidelines
    • A focus on consumer-centered personalized care
    • An integrated approach to care that combines sick-care with well-care (e.g., prevention), medical care with psychological care, and traditional medicine with complementary and alternative medicine and genomics
    • Changes in current economic and competitive models
    • Use of innovative HIT architecture and tools within the only comprehensive HIT blueprint covering everything from first responder support in emergencies; to the coordination of care across the entire healthcare continuum; to practitioner-researcher collaboration; to global outcomes research for knowledge-building and sharing, and for evidence-based decision support opitimization.
    P4P and transparency are two tactics that, if done correctly, may help our country implement such a solution, even though they add their own sets of obstacles.

  2. We need to attack the cause and not the effect. Health care costs are 30% higher than they should be because physicians profit from the tests they order in their office, which usually includes a well-equipped lab that serves as a cash cow. Follow the money! We need to strengthen the Stark laws to prohibit such self-referrals and misuse for the purpose of profit making.
    Performance transparency is tricky and could instead discourage physicians from taking the more difficult patients because they will have a negative affect on their stats.

  3. No other nation in teh world uses P4P. I see no reason to use it here. The problems with our healthcare system is that we are TOO DIFFERENT FROM EVERYBODY ELSE ALREADY. Moving furhter in that direction by some kind of P4P scheme is a fundamentally wrong idea.
    Instead, we shold mimic other nations. Single payer, non-P4P based healthcare.