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Sachin H. Jain, MD, MBA on Physician Incentives that Improve Clinical Outcomes

Today we are delighted to welcome Sachin H. Jain, MD, MBA as a Keynote Speaker for this Breakthrough Opportunities event on Designing Provider Incentives with the Commonwealth Fund.

Dr. Jain is Chief Medical Officer at CareMore Health System/Anthem and Consulting Professor of Medicine at Stanford University School of Medicine.

In this video, Dr. Jain shares how lessons learned from the CareMore model can be used to design other successful incentive programs.

We look forward to hearing your thoughts on Dr. Jain’s video below, and encourage you to submit ideas sparked by the topics covered: http://www.ghdonline.org/designing-provider-incentives/submit-idea/

(Note for those viewing this update via email, please click through to view Dr. Jain’s video on GHDonline: http://www.ghdonline.org/designing-provider-incentives/keynote/sachin-h-jain-...)

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Paul Nelson Replied at 12:53 AM, 13 Dec 2015

Saturday 12-12-15

The 'Big Idea' week is over. As intimated by Dr. Jain and others, an improvement in the availability, accessibility, efficiency and effectiveness of healthcare will not be successful without the leadership necessary to promote the social capital required for managing a common-pool resource. Per Nobel Prize Winner Elinor Ostrom, Social Capital should be viewed as the attribute of individuals and of their relationships that enhances their ability to solve collective action problems. Her research over many years, along with many colleagues, led to a set of Design Principles for the use of collective action as a basis to preserve a commons (common-pool resource). She has identified trust as the principle "attribute" for the success of promoting Social Capitol. As a Primary Physician, I view he lack of trustworthiness among the healthcare institutions as one of our greatest problems. The exorbitant cost of our nation's healthcare as represented by its portion of our national economy is bankrupting our nation. Not one idea, so far, will drive its improved efficiency or effectiveness, community by community.

I note there is no other comment below this one, as I create my Commentary. The work environment described by Dr. Jain can be reproduced any where. My own work environment has its core competency committed to Caring Relationships as defined by "A variably asymmetric relationship between two persons who share an intent to enhance each other's autonomy using beneficent communication with warmth, non-critical acceptance, honesty and empathy over an extended period of time." These four attributes form the means for establishing Trust, not only among the staff of a Therapeutic Community within a clinic but also with the citizens they serve. Each caring relationship ultimately is the rate limiting gate for healthcare that is equitably available, culturally accessible, justly efficient and reliably effective for the Basic and Complex Healthcare Needs of each citizen. We are the only developed nation of the world with a worsening maternal mortality ratio, for 20+ years.

Our nation's future autonomy within the world-wide market-place arenas of RESOURCES, KNOWLEDGE and HUMAN DIGNITY is at stake. The world's population passed 7 Billion 4 years ago. I am led to believe that it will be 10 Billion in 2050. I personally belief that it will take a new semi-autonomous institution established by Congress and supported by each State's legislature will be necessary somewhat like the institutions established by the 1913-14 Congress for the NATIONAL RESERVE and the Cooperative Extension Service. The high cost of our nation's healthcare will not be solved with out the Social Capital to achieve equitably available Primary Healthcare for every citizen, community by community, within ten years.

Paul

Madhuri Gandikota Replied at 11:32 PM, 14 Dec 2015

At the outset, Thanks to Dr. Greene for sharing such insightful study. In this regard, Dr. Greene’s comment on the complexity of diabetes management-the metrics such as Tobacco cessation, hypertension control, are indeed difficult to manage in a short term and then compensate physicians for their performance. I would still dissect these metrics and manage them-say cardio-metabolic profile for a group of patients in the last three months. Primary care physicians provide care to individual patients for one condition, understanding of the entire patient population based on Risk-stratification becomes relevant. In my opinion it is important to look into a disease as a set of patient inter-related conditions.

On a related note, I agree with Om, that Policy level changes need to occur. Understanding the health of the community, local environment, socio-economic, ethnic context is very important to bring in change/improved outcomes.
Today, in US and in most of the developing countries (Eg. India-Despite Digital India campaign), do not have public health professionals interacting with the providers. While in US and in other developed countries, significant public funding goes into the National Surveys and data collection, seldom such data is considered by providers at the point of care. So, in my opinion it becomes relevant to take into consideration of the entire population, local community and how it behaves.

I am understanding, that in case of India, a new surgeon (after 12 years of post-college education) the monthly salary in a competitive medical institute is about 2000 USD per month. While the compensation for a corporate doc, for one surgery is almost the same. So, I wonder what the provider incentive in Medical institute is. Phasing out a bit, a 4 year Engineering graduate makes, >3000 USD per month. I wonder what is the next generation doctors/researchers would come from.

Also, for India, Understanding population is difficult because public health data is scanty, and need less to say that any interaction of public health with providers is non-existent. Perhaps, this requires ramping up public health data collection first to understand the communities. I also wonder, how can Health Sector leverage the Digital India campaign to solve fundamental health issues in India

This Community is Archived.

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