Have it both ways...

Read two interesting articles last week about "the health care mess." Actually, they purported to be about different subjects, but I relate them both to The Mess.

First was "Payers can drive healthcare transformation with IT help", a report on consumer-directed healthcare -- or, more to the point, what payer organizations have to say about, and have to gain from, use of sophisticated IT technologies to make delivery of service more beneficial to the consumer. To the patient. For example,

Health plans have been piloting incentive programs, including pay-for-performance, practice rewards and employer waivers for drugs for employees in disease management programs, and seeing significant uptake...[It was] stressed that the fundamental strategy for appealing to providers and consumers is to get the information into the hands of providers and democratizing information and getting it to consumers.

Second was another innocuous little report on incentives, "California Hospital Association sues Blue Cross on payment policy." This too purported to place the interests of the consumer -- of the patient -- in the forefront. Here's the issue in this case:

The California Hospital Association is suing Blue Cross of California, claiming a new policy by the health insurer will violate state laws because it would pay doctors who opt to perform endoscopies in hospitals less than those who do so in less expensive outpatient centers... "(Doctors) are supposed to make decisions unhindered by financial considerations," [the CHA
spokesperson] said. "They're supposed to make them solely on the medical well-being of the patient."

Who, I wondered when I read the two articles together, and reflected on the positioning that I must imagine is constant among payer, provider, and patient-advocate organizations, has the best interests of the consumer at heart? Of the patient? The CHA action centered on (or orbited around) endoscopies; but you can bet this argument is gonna heat up once we start looking into more involved procedures. The incentives posed by the Blues, as I understand it, would encourage use of distributed endoscopic facilities outside of hospitals to handle an increasing flow of subjects (consumers, patients) for the procedure. The hospitals, it seems, cried foul, claiming a disregard for issues of patient safety and treatment quality on the part of payers who were compromising docs by "forcing" them into financial rather than medical considerations for treatment.

I was considering both sides with impartial interest -- until I read in the second reference the rebuttal from a WellPoint spokesperson (parent of the Blues):

Alaniz said the payment policy is merely an incentive for doctors to do the procedures in such centers. Endoscopies can cost between $300 and $500 in ambulatory surgery centers, compared to between $2,100 to $6,000 in hospitals, he said.

So, I wondered -- if I were an advocate of an organization that has established, high-quality processes for critical treatments, and I were threatened by delivery of same services at 1/4 to 1/7 the cost (!!), just what would I do?? Then I wondered, if I were and advocate of a consumer-oriented organization that constantly seeks the best established, high-quality processes for critical treatments -- you know: if I were a patient -- then what would I do??

Gee, I wish I could just have it both ways.