Healthcare Cost & Quality – Who Cares (for the patients)?

By Andy Rocklin June 19, 2013

Supported by vast claims data assets and pressing financial imperative, health plans are increasingly influencing care delivery decisions. At the same time, healthcare providers are not passively ceding control of these decisions. To understand the developing dynamic and where it may be headed, imagine a screenplay on subject. (It wouldn’t be a blockbuster, but might interest you if you’ve read this far).

The setting: Prodded to meet by a patient advocacy group, executives from the local market’s leading payers and providers sit on opposite sides of a table in a vaguely familiar but not quite identifiable conference room. Looking younger and less polished than everyone else, the patient advocate sits at the end of the table, pen in hand, and a new, empty notebook in his lap. Though their objective is to find common ground around ways to improve community health, each side has packed their briefcases with their own respective agendas. Responding to healthcare reform mandates and market pressures, payers focus on economically sustainable ways to reduce medical loss ratios, lower premiums, and demonstrate quality. Facing a different set of regulatory and market demands, providers are focused on improving care, curbing cost growth, and learning how to manage the financial risks of outcome-driven reimbursement.

The scene opens with both sides thumping their chests and attempting to seize the moral high ground with payers claiming credit for making healthcare affordable and accessible while providers echo choruses of the Hippocratic Oath. Once the posturing subsides, the patient advocate quietly goes to the whiteboard and jots down four words:

whiteboard for blog


He then turns to the group and says, “Even though you each have different motivations and responsibilities, don’t you hold these core objectives in common?”

After some murmuring and contagious head-nodding, the group sees the promise of alignment – at least around shared problems and the desire to solve them.

Unfortunately, this Kumbaya moment is short-lived. As the action-oriented personalities turn towards solving the problem, bigger areas of dissent emerge. Envisioning the future, the group is split between two contrasting yet plausible futures. This time, however, the opinions don’t divide neatly on each side of the table.


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