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Doubling Down on ACOs and Health Information Networks

flying cadeuciiWant to achieve effective health care, reduced costs, increased quality, population health, widespread prevention and seamless health information access?

It’s easy, says this article in Population Health Management: mix one part PHO with one part HRB to create a HAPPI.

This correspondent was confused too, but that’s what’s proposed by three smart academics from Johns Hopkins, Arizona State University and UC Berkeley.

As I understand it, Population Health Organizations (PHOs) would be responsible for all medical, public health, community and social services in a defined geographic area and coordinate them with local education, housing and labor. Much of it would be paid for by a pooled risk-adjusted global or capitated payment (budget) from all insurers.

Each organization would be paired with a Health Record Bank (HRB), which would act as a huge data warehouse that not only stores all medical information, but any other publically available information on every individual enrolled in the PHO. The HRBs would be owned and operated by “trusted custodial organizations.” Data access would be ultimately controlled by each patient.

The authors believe that patient payments would be a source of additional revenue for their PHOs. Examples include buying “apps” that are tailored to their individual health needs, or selling their personal health information, especially if it means helping physicians buy an electronic health record or access cutting edge research.

Combine a PHO and HRB and you have a Health and Prevention Promotion Initiative (HAPPI). Its size and scale would warrant contributions from community and provider organizations “without the need for additional reimbursement or outside funding.” It would efficiently “align incentives” for insurers, hospitals and ACOs – with money left over for prevention, care coordination, decision support and a learning health system.

Breathtaking, isn’t it? If any readers thought accountable care organizations (ACOs) and health information networks (HINs) weren’t big enough, along comes Tyrannosaurus rex-sized PHOs, HRBs and HAPPIs.

This correspondent worries that while we’d want to see how pint-sized ACOs (not a slam dunk) and HINs (likewise not a slam dunk) perform before we apply the massive steroid doses, the opposite could happen: their messy failure could be just the justification for doubling down and going even bigger.

As pointed out in a recent Wall Street Journal Notable and Quotable:

Economist Michael Munger writing in the Freeman, Aug. 11:

When I am discussing the state with my [academic] colleagues, it’s not long before I realize that, for them, almost without exception, the State is a unicorn. I come from the Public Choice tradition, which tends to emphasize consequentialist arguments more than natural rights, and so the distinction is particularly important for me. My friends generally dislike politicians, find democracy messy and distasteful, and object to the brutality and coercive excesses of foreign wars, the war on drugs, and the spying of the NSA.

But their solution is, without exception, to expand the power of “the State.” That seems literally insane to me—a non sequitur of such monstrous proportions that I had trouble taking it seriously.

Then I realized that they want a kind of unicorn, a State that has the properties, motivations, knowledge, and abilities that they can imagine for it. When I finally realized that we were talking past each other, I felt kind of dumb. Because essentially this very realization—that people who favor expansion of government imagine a State different from the one possible in the physical world—has been a core part of the argument made by classical liberals for at least three hundred years.

11 replies »

  1. To really succeed, health record banks will have to address malpractice liability. As long as physicians and practices bear the full burden of liability, they have little incentive to trust the data from any system or provider other than their own.

  2. The report carries great significance in terms of the important points it mentioned. The health care policies are my main concern and other people.

  3. I am far more concerned with maternity overall health troubles rather than anything else. You report highlighted some crucial components, I was looking for. I wish that everybody of us can avail the greatest health facilities regardless of the earnings. Our politicians have to function and take step to boost the excellent of life of basic citizens.

  4. I am more concerned with maternity health issues rather than anything else. You article highlighted some important factors, I was looking for. I wish that everyone of us can avail the best health facilities regardless of the income. Our politicians have to work and take step to improve the quality of life of general citizens.

  5. BTW, the post was a bit difficult to read. Perhaps, I am not familiar with the terms that why it took me some time to understand the abbreviations.

  6. I always seem to be concerned about health care policies. It seems like the combination of PHO and HRB are worthwhile.