By Harvard Health Care Policy Professor Michael Chernew
The basic goal: Build payment models like population-based payment, where the delivery system assumes accountability for the full amount of spending and individual clinical outcomes, and bundled payments, assuming accountability, for an episode of care, and allow the provider system to rearrange the resources they need to provide that service or care for that patient more efficiently and share some of the fiscal savings it generates.
“We call those payment models, commonly, value-based payment, but in my view it’s just a misnomer,” says Chernew. “The word ‘value’ is simply the sugar that makes the medicine go down. This is about risk transfer.” Someone has to control what goes on, and someone has to have the incentives to control what’s going to go on.
“Frankly, as providers, you’ve drawn the short straw,” he says. “You may not have gone to medical school to learn how to save money, but increasingly the delivery system is put in the situation where they need to save money or at least control the rate of growth and spending.”
From the NEJM Catalyst event Disrupting the Health Care Landscape: New Roles for Familiar Players, held at NewYork-Presbyterian, October 25, 2018.
Nine minute video and transcript:
By Don McCanne, M.D.
Nowhere in his comments does Harvard Professor Michael Chernew even mention single payer, and that’s the point. He is describing the status quo of the prevalent health policy views on health care financing – a vision with which we will have to live indefinitely as there would be no future role for single payer.
Set aside nine minutes to watch this video, and then a few more minutes to recover, but use that recovery time productively by thinking about the following. Instead of a vision of a system in which the “providers” are put at risk to control spending for the benefit of the payers, refresh your vision of a system in which health care professionals and institutions are dedicated to providing optimal care for the patients in a system which automatically allocates health care spending with that goal in mind – efficiently, effectively, equitably, and affordable for all – with no necessity to give thought as to how the care will be financed, any more than you would give thought about how the fire department will be paid as they are putting out a fire in your home.
Do we really want to live with a system in which the provider’s role is to curb health care spending? No? Then it’s time for bold action.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.