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Provider Driven Benchmark System

Submitted by Marie Teichman | 01 Dec, 2015

There should be a stratified benchmark system, so that no provider is too far away from an attainable goal. This could be accomplished by monitoring performance statistics and creating various targets for provider performance. Within each level of the system, providers will be ranked against peers in order to foster competition and improve performance levels. By not comparing providers in different performance tiers, there will be less discouragement for lower performing providers to continue improving and working towards their target performance level.

Each target could focus on various goals relating to the providers’ needs. Whether that be decreasing costs of services provided by prescribing generics first or using less expensive technologies and tests. This system should be implemented and created by the providers themselves in order to dissuade any influence from the payers.

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Edgar Wilson Replied at 3:59 PM, 1 Dec 2015

And all of this information should be transparently available to patients, so they can see both goals and records of performance, and decide which benchmarks are important to them--and determine whether potential providers have appropriate goals, or a satisfactory record of meeting them.

Kenneth Croen Replied at 7:02 AM, 2 Dec 2015

The issue of benchmark is critically important. I agree with Edgar WIlson. The MSSP ACOs have benchmarks that range from $5000 to $22,000 per person per year. In my community, there is an ACO with a benchmark of $8900. A few miles away, a Pioneer ACO has a benchmark of nearly $16,000. A patient will look at this information and realize that the higher benchmark ACO may be less restricted in the care that they offer. The discerning patient may begin to wonder how much does each ACO allocate towards cardiac care, the management of rheumatoid arthritis, or Hep C treatment. Of course none of this information will be known in our non-transparent healthcare environment. But patients will wonder....and so should providers.
As for incentivizing to make providers change their ways - it has not worked to date. The MSSP and ACO program saved just $9.2 million after $401 million was given out as a bonus in 2014. The cost of care for that population of patients was nearly $60 billion. The net savings was 0.01% and does not include the huge administrative costs that CMS incurred. It is not clear what we hope to gain with this model of healthcare.

David Cawthorpe Replied at 11:46 AM, 3 Dec 2015

It gets better! Longer life expectancy leads to piling up of chronic diseases in last years of life. Comorbidity reigns in this realm and for that matter across the life span. For example, in a whole population over 16 years, health costs increase at the rate of inflation, with one comorbidity (mental disorder) indexing the major cost components. Reference papers in the links!

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Radha krishna Behara Replied at 1:01 AM, 7 Dec 2015

Interesting discussion. I was looking at this in a different perspective and submitted my Idea. it is still not visible here. My idea is to look at the constraints regarding monetary benefits for incentivizing providers and focused on alternative benefits for providers.
We all crave for Recognition and that i felt is the human beings Intrinsic nature.
This is proven by the huge successes of Social websites such as Facebook, Twitter and LinkedIn and this GHD forums.
So keeping that in Mind My idea i submitted focussed on increasing the Branding of the provider and his/her Hospitals while they perform quality service..
The point is other than money all our world class physicians love to do well if their efforts are duly recognized and appreciated.
What do you think guys? Let me know
Thanks for reading this.

Paul Nelson Replied at 7:10 AM, 7 Dec 2015

Hmmm! The Design Principles that are required for the collective action to manage a "common pool resource" most likely apply here. For healthcare, the Common Pool Resource or COMMONS is the portion of our national economy allocated to healthcare. As of last month, the commons represented 18.3% of our national economy. All of the other developed nations of the world use 13% or less of their national economy for healthcare. Currently, the difference between 13% and 18.3% represents $1 Trillion Dollars. The excess cost is underwritten by the Federal government by an expenditure of $400 Billion annually. In effect, the excess cost of our nation's healthcare industry represents the largest contributor to our nation's annual DEBT. That annual debt is accumulating at a rate that will eventually create an indebtedness equivalent to the citizens of Greece today.
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We will need to invest in the social capital of each community of 400,000 citizens to improve our inefficient and also ineffective healthcare system. Remember, we are the only developed nation of the world with a maternal mortality ratio that has gone up over the last 20 years, at 1.7% a year. It is likely that at least 400 women die annually related to a pregnancy that would not have occurred if they had lived in a nation with equitably available and culturally accessible healthcare for the Basic Healthcare Needs of each citizen, community by community.
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See Link below for one proposal to reform our nation's healthcare through an investment in the social capital of each community. The concepts already well known and clearly identified by Professor Elinor Ostrom and many colleagues apply. She was a 2009 Nobel Prize winner for her life long professional career.

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Denali Dahl Replied at 12:12 PM, 14 Dec 2015

Thank you for sharing your thoughts. I think providing incentives for health care practitioners is an interesting concept, but largely unrealistic in developing countries. In the developed world where physicians are fairly abundant ensuring quality through an induced competition system makes sense. In the developing world where there may be a couple physicians for a large population, the competition system will be irrelevant because the few physicians are going to practice health care however they want to. With limited resources it is harder to have checks and balances, since there really isn't an alternative if the physicians don't meet the set expectations. I think ensuring quality care in low-resource settings is important, but I think focusing resources on training programs and encouraging new health care workers would be more beneficial.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.