On Feb 26, 2018, Delmarva Foundation, Health Integrity, Quality Health Foundation, and Quality Health Strategies came together under a new name: Qlarant.  The following content was created prior to this change and may contain our old name(s).  Learn More

Not What You Wanted To Hear

Do you like being told no? Of course not. Who does? Maybe crazy people but certainly not your average run of the mill person. We all like to get our way and get what we want. That is human nature. We are needy beings that want want want. However, even Mick Jagger knew that we don’t always get what we want.

Hey now, don’t give me that look. I can see you giving me an eye roll and moving that mouse to close the browser window. Just stop for a minute. I have a point here. I promise.

Our modern culture is built on the premise that anything you do can be made faster and/or more efficient with the incredible power of (fanfare please) the internet. I would venture to say that in a lot of ways this is true and if it doesn’t make it faster than at least it’s more convenient. Shopping is easier, taxi rides are easier, education is more accessible, banking is easier, and meeting new people is as simple as a swipe right. So what about healthcare?

A few posts ago I spoke about how the data we leave behind us can be analyzed to make our healthcare easier and cheaper. As a consequence of that efficiency and cost-effectiveness, we may not get the care we are used to or even the care that we feel we want. This isn’t because we are getting subpar care. It is just that we don’t necessarily need everything that might have been done in the past. It is that efficiency and cost savings at work. That fact is that you as a patient may not have much control over your care at all. That may or may not be such a bad thing but I can think of a few situations where someone might get a little ticked that they are told no. Sadly, in our modern world, some adults seem to turn immediately into toddlers when they don’t get their way. Just watch the customer service counter at your local big box store when someone is told they can’t return the doodad they bought 3 years ago… Epic meltdowns for sure. It’s the kind of stuff viral videos are made of.

Now back to the story. Coordinated care groups, cooperatives of providers, and even the participants within a payer network may not allow a patient access to certain procedures they deem unnecessary or superfluous or allow a patient to see anyone outside of the confines of their group. Why you ask? Because they feel that if they control what procedures are done and who a patient gets to see for a specific procedure then they can guarantee the quality and the cost of an entire episode of care. And if they cannot guarantee it then at least they would have a pathway to open communication to make sure they can adjust or understand better the care a patient receives. So that means that patients can’t really choose who they get to go to or whether or not to get the “extra” tests that somehow make them feel more trusting of the care they are receiving. Despite the fact that healthcare should be all about choices, those choices may start to dwindle and if you start an episode of care, say for a surgery, with one group then you likely won’t be able to move to another.

woman with steam coming out of her earsNow I imagine a lot of you thinking “What is this guy talking about? Of course I can choose what doctors I see and what providers I want to use.” But if you think about it, I don’t mean that you can’t choose what you want, only that you won’t be able to do so without consequences. A doctor who is being paid based on the health outcome of your care will be hesitant to let you out of their “area of influence” so to speak. Also, your insurance company will not be pleased and may force you to pay more if your choice moves you into a situation where quality can no longer be measured effectively. (This brings up the issue of how to measure quality which is not an easy question to answer.) There is a silver lining here though. Remember that things would not be as they are now. If you are in the midst of an episode of care it is likely that the group doing the treating is already pretty good since they will get paid based on the quality of care that they administer and not just by the procedures they complete.

So remember that even though value-based care may mean that you don’t get the same things that you used to, it also means that you are probably getting a better deal anyway. Everyone wins but only if we let the system work for us and try not to work against it. It is hard to lose control (if we even had it to begin with) but giving up some things means we can reap the benefits elsewhere. In this case, your bank account or in a more grandiose fashion the coffers of the whole country. Nothing is ever perfect but if we let the change take hold we can all be better off. In closing, I challenge you not to start humming the Rolling Stones after you read this. I said no. Don’t you do it!

See the theme here?

 

Disclaimer: This Blog is for educational purposes only as well as to provide general information and a general understanding of the topics discussed.  The Blog should not be used as a substitute for legal advice and you are advised to seek additional information from your insurance carriers, Medicare and/or Medicaid agencies for additional criteria and regulations regarding these services.

about the author

A portrait of Kevin McCash

Kevin McCash, PhD is a data analytics manager, an avid reader and trivia buff. Kevin enjoys friendly arguments, deep discussions and above all learning new things. See all posts from Kevin McCash.

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