Care Redesign
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Winners, Losers, and Staying in the Game (09:47)

When it comes to care redesign, with any change, there are winners and losers. What’s the difference between the winners and the losers? Thomas Graf, National Director of Population Health Management at The Chartis Group, sat down with CMS’s Patrick Conway and François de Brantes of the Health Care Incentives Improvement Institute to discuss how to get into — and stay — in the winner’s group.

According to De Brantes, it’s not about the organization or the physicians — it’s about the patients. “As long as what we’re getting are really great patient outcomes, does it matter?” he asks.

“We’ve seen the organizations with a culture of transformation are often more successful. However, we’ve seen that organizations who didn’t have that culture can build it, with the right incentives,” Conway says.

But, he explains that when it comes to balancing “middle-of-the-road folks” with “the laggards,” it will probably come down to a different set of interventions, including some realizing that their current model of operation — which isn’t as focused on the patient and desired outcomes — is not the model that’s going to succeed.

De Brantes, however, doesn’t see the laggards as any less motivated to deliver good care as anyone else. “I think what they are prizing is autonomy,” he says. “This tendency to start with, well, if you’re not in some big integrated group that we’re going to shove a bunch of people at, then you’re in the game. That’s not true,” he says, offering Bas Bloem’s ParkinsonNet as an example.

“There’s no fundamental reason why, with good exchange of clinical data and a community, that you can’t have a number of primary care physicians working with a pulmonologist, a cardiologist, all of whom can have independent practices,” de Brantes says. “If I can assemble that network of excellence because I have access to it and I know who’s there and they’re working together, and their information is linked together, then why not?”

Conway agrees. “We’re actually seeing this,” he says. “People thought with the various ACO models and bundles, the big integrated systems would always be the winners. It’s not true. So, when we look at the performance, it really is those cultural organizational factors: we’ve got small physician-led that are incredibly successful, we’ve got urban that are successful, rural that are successful, all regions of the country that are successful across these models, so actually I agree.”

It’s not the form, he says, stressing that they’re not trying to dictate form, but rather a culture of improvement and change. Some organizations already have this, and some will need help getting there.

“We’re trying to design an array of incentives that will work for the various organizations and clinicians that exist,” he adds.

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

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