Care Redesign
Clip
Patient-Provider Conflict: The Perfect Environment (03:54)

Those in the provider community might say, we tried to change the game in the ’80s and ’90s, and it didn’t work. So when it comes to balancing payment reform with putting the patient first, why do we play the same game if we get the same results?

There are fundamental differences between then and now, says Patrick Conway. The majority of the transformation that we see now is provider/physician/clinician driven — and the majority is voluntary. But he thinks we have some work to do with patients, adding that he doesn’t think we’ve done a great job of explaining what this actually means for real people.

“But I think our approach is quite different in terms of really having it be driven by the delivery system,” Conway adds. “And this one we’re going to need to continue to monitor, because if we go too far in the other direction, it doesn’t feel driven by the people in the delivery system, including the patients and providers, and it could have a real negative pushback.”

François de Brantes explains that one area where we failed the last time around is that by reforming payment, we failed to reform benefit design at the same time. “We created a perfect environment for conflict between the patient and the provider,” he says. For example, in the old days of “HMO $5 all-you-can-eat buffets,” patients will choose extra medical care, such as lab tests, because it’s no difference to them. But the provider, appropriately, doesn’t want to give that test because it might be unnecessary, says de Brantes.

“So you have a conflict. And this time around, that’s really a big difference because at least in the commercial sector, the volume of co-pays, the cost-sharing that commercially insured client members have to dish out, really does [create], from many perspectives, a better convergence between the patients’ interests and the providers’ interest,” de Brantes says.

But we also see zone detention. “For example, you can emphasize preventative care — that’s fine, because it’s covered in full. Secondary prevention is a big problem, because of course if the providers are held accountable for excessive ED visits or hospitalization of a patient because it’s a complication, then they’re going to want their patients to be more compliant, they’re going to want the lab tests, and the patients have to pay for all of that out of pocket.”

He adds that this is a growing concern in the commercial sector, because if we don’t figure that piece out, then the conflict remains between the provider, who is deliberately trying to deliver better care to the patient, and patients feeling as though they’re getting “sucked in” to doing a test that they don’t need.

To that end, de Brantes agrees with Conway that we have to do a far, far better job at trying to explain to people what all of this means.

 

From the NEJM Catalyst event Care Redesign: Creating the Future of Care Delivery at Kaiser Permanente Center for Total Health, September 30, 2015.

More From Care Redesign
How Adequate Are Your Organization's Mental and Behavioral Health Services to Meet the Needs of the Patient Population?

Care Redesign Survey: It’s Time to Treat Physical and Mental Health with Equal Intent

By neglecting mental and behavioral health, our society has made it virtually impossible to succeed in holistic health, and thus to improve health outcomes.

2015 and 2016 Gallup Sharecare Well-Being 5 Key Metrics Data for NCH Healthcare System Blue Zones Project Life Expectancy

Decreasing the Cost of Care by Avoiding Illness

NCH Healthcare System’s success in lengthening life expectancy and improving health and happiness for its community while lowering health care costs for large employers is an example worth emulating.

Optimizing Diversity and Inclusivity Real People Providing Feedback on Precision Medicine Study Design Precision Medicine Initiative for All Community Medicine

Precision Medicine for Everyone

Until we create an environment where diverse patients are considered participants as partners, the goals of individualized research, prevention, and treatment will be unrealized.

Preventable Contributions to Death in USA Public Health Social Determinants of Health Mental and Behavioral Health

Up-Streamism: Health in the 21st Century

With a concerted effort that incorporates principles of understanding, engaging, and connecting with diverse communities, health care leaders can impact patients’ lives early on, preventing adverse conditions and improving outcomes.

Findings from NYC Health + Hospitals ED Care Management Program

Learnings from a Large-Scale Emergency Department Care Management Program in New York City

A CMMI-supported interdisciplinary care team effort helped a safety-net system strengthen primary care engagement and identify unmet needs.

Chronic Treatment Is Not “One and Done”

Clinicians need to adopt a holistic approach to care, particularly for older patients with chronic and comorbid conditions.

virtual visits nonvisit health care

In-Person Health Care as Option B

What if health care were designed so that in-person visits were the second, third, or even last option for meeting routine patient needs, rather than the first?

Innovative Health Care Organizations - Organizational Designs for Innovation

Small Improvements versus Care Redesign: Can Your Organization Juggle Both?

What are the best ways to introduce innovation capacity into your organization?

Key Recommendations from the National Academy of Medicine Applicable to Health and Social Services Professionals

Creating Healthy Communities after Disasters

Recommendations for health and social service professionals to translate the compassion generated by aftereffects of natural disasters into tangible actions applicable to their own communities.

Family Physicians EHR Use by Time of Day

Infographic: Date Night with the EHR

Studies have found that physicians spend nearly 30 hours per month working on the EHR in their homes — including morning and evening hours over the weekend.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Care Integration

54 Articles

The “Stranger Effect” — A Look…

Why do miscommunications between teams and consultants occur, and what can we do about it?

Care Redesign Survey: It’s Time to…

By neglecting mental and behavioral health, our society has made it virtually impossible to succeed…

Primary Care

135 Articles

Care Redesign Survey: It’s Time to…

By neglecting mental and behavioral health, our society has made it virtually impossible to succeed…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now