Gary Passama

Gary Passama retired as president and CEO of NorthBay Healthcare on March 31, 2017. An active blogger since 2010, here’s a collection of his work.

Consultants Have to Eat

January 27, 2015
 

Let's start off by getting two definitions on the table, spelled out courtesy of The Governance Institute, an organization that provides education to directors of healthcare systems, hospitals and medical groups.

Definition 1: Population Health: The "distribution of health outcomes within a population, the health determinants that influence distribution, and the policies and interventions that impact the determinants." (Could that be any clearer?)

Definition 2: Accountable Care Organizations: A "set of providers that have the ability to manage the full continuum of care for the patients within their provider network and that receive financial incentives to improve the quality and efficiency of care." (We used to call these creatures "HMOs," but consultants busy peddling accountable care organizations have decided to rebrand.) Healthcare is prone to fads that repeat themselves. "Population Health" and "Accountable Care Organizations" are the latest manifestations of that. In truth, there are some positive aspects of these cycles. They sometimes force those of us involved with health care delivery to reconsider how we do things.

What I object to is the idea that each new recycled idea is the panacea to the healthcare cost conundrum. Working to educate people about how to improve their health status is a good thing. Expecting that will spur lower costs may be a false expectation. Studies about the effectiveness of such an approach are at best mixed.

I recently heard an expert speaker on accountable care organizations address the subject. He went to great - but to me unconvincing - pains to differentiate how this time around we can achieve higher quality care and lower costs as compared to the 1990s when HMOs made similar claims. He did concede that the development of accountable care organizations has been slower than he expected and that there are no conclusive results. He foresaw a future where accountable care organizations would coexist with other approaches. That in itself is a retreat from the claim by many pundits that accountable care organizations are "the future."

As often stated here, NorthBay Healthcare is an owner of Western Health Advantage, a nonprofit HMO with integrity and commitment to the needs of its members. It is often the low-cost provider. So we have an oar in the water. Kaiser Permanente is the granddaddy of HMOs and a major player in California.

It is often cited as the prototype for population health and accountable care organizations. But the good it may have done for its members has not solved the cost problem.

With its high legacy costs in its hospitals and medical group it remains relatively high priced in the marketplace. It is often undercut by lower-cost plans such as preferred provider plans. I may live to regret these words, but I will state it here. "Population Health" and "Accountable Care Organizations" are the latest fad almost certain to be replaced in a few years by new buzzwords. After all, consultants have to eat. To do that, they need something to sell. Maybe that stamps me as a primitive, someone not suitable to break bread with "experts."

Tags: accountable care organization, population health, ceo, gary passama

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