Re: System Collaboration vs. Silos of Care

[Guest guest]

I belong to a large PHO that has done this. There is a very elaborate P4P arrangement with many insurance companies. The specialists, hospitals  and PCP's are all involved. At year end we get a bonus based on how well we did. The PHO provides a disease registry and they are starting to fill the data fields for you if you use their lab. ( Some bugs remain). My bonus came out a little over 7% of my collections for the insurance companies that were included.  Larry Lindeman M.D.Roscoe Village Family Medicine2255 W. RoscoeChicago, Illinois 60618www.roscoevillagefamilymedicine.com Currently, payers are focussed on judgment programs in an attempt toimprove cost and efficiency. However these approaches are proving tobe faulty as they do not offer transparency around data collection,are inaccurate in their data collection, do not assign cost in anequitable manner, and in effect place blame rather than spur behaviorchange.Lessons from the business world tell us that the best way to achievesuccess is to form partnerships amongst the stakeholders based uponmutually agreed upon goals and a sense of shared benefit.This means we have to transition from silos to collaborativearrangements. I do not think this means no solo settings, I think itmeans work as a team.I would be interested in specific examples or ideas wherebypractitioners have collaborated to achieve a desired outcome. For example, using the p4p concept, practitioners could carefullyselect a desired disease with ample evidence of need for improvement(A1c) and then examine the episodes of care (office visits, labvisits, nutritionist visits) associated with that disease and all ofthe stakeholders associated as well (Endocrine, FP, nutritionist,etc). The stakeholders would collaborate to identify mutually agreedupon goals (all A1c's less than 6.9) and then collaborate on how toachieve this. The p4p reward would be based upon behavior changes(collaborating) as well as achieving target measures (50% less than 6.9).I think an approach that rewards practitioners for collaboration ismore likely to achieve results than programs that essentially placeblame. I think that physicians who show willingness to participate inan integrated solution should be rewarded financially.Lowell