Working with Payers to Keep Patients Healthy

by webadmin on January 18, 2013

Are you a CEO who would like to see fewer patients using your hospital’s services?

This is an interesting question and one that is addressed in an intriguing article by Philip Betbeze at HealthLeaders Media.

Using Allen Weiss, MD, CEO of NCH Healthcare System in Naples, Fla., as his example, Betbeze asserts that most healthcare leaders would like fewer people using their services since hospitals are “for serious illness,” and thus expensive and “often deadly.” Furthermore, there’s “the unsustainable cost trajectory of healthcare [that] threatens their continued existence.”

However, maybe you’re like Weiss, who is among those medical professionals who believe that spending will eventually level out. As a result of this belief, Weiss is becoming a pioneer of unprecedented incentives designed to keep hospital beds empty.

Currently, Weiss is establishing partnerships with commercial payers that are less distant and competitive than before. His first partnership is with Blue Cross and Blue Shield of Florida with whom NCH has agreed to share claims data.

In the first few months of this collaboration, NCH discovered that its physicians were managing waste effectively. However, hidden waste was still an issue, and the system and the payer determined that “a combination of resources could make real-time interventions on physician decision-making based on evidence possible,” Betbeze writes.

For one thing, NCH discovered that they were doing too much thyroid testing and have since established new standards for when to give thyroid tests. Digging deeper into its processes, NCH is now working with Blue Cross and Blue Shield on cutting back the number of radiological procedures that are performed, one third of which are unnecessary.

Weiss believes that this close collaboration “will provide ‘almost real-time feedback’ that NCH’s physician medical director will be sharing with physicians.”

After the collaboration completes its examination of processes, they will move on to outcomes.

It’s a comfortable partnership, Weiss asserts, because there’s no real pressure. It’s all voluntary with nothing to lose.

“It’s like learning day at the casino,” he observes, and eventually, he hopes that the data sharing will lead to payers providing the system with their profit margins, a disclosure that would help NCH greatly.

Says Weiss, “If we can get to that point we have it made. We’ll be like the Maytag repair guy, which gets them away from paying us for sickness. That’s the tragedy of the current system. We can’t afford to continue to do what we’ve done.”

What are your thoughts on Weiss’ approach to keeping patients healthy and out of the hospital? What incentives would you suggest? What incentives has your organization adopted to reduce unnecessary testing and expenses?

-by Pete Fernbaugh

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