Providers not aligned with market forces

Of the three major categories of players in the health care system - patients, payors and providers, the first two are aligned in their driving interests - better health, lower intensity of interaction with the providers - make up for better quality of life for patients, better profits for payors. The competition among the 160 insurers (plus Medicare) leads to systems which offer better outcomes for employers (and thus patients) - whether this is the Patient Centered Medical Home, or Patient Portals, or Personal Health Records, or EHRs that interoperate and give access to CCRs that are kept in globally accessable PHRs.

These forces also make feasible care managers who would work with patient and provider to ensure that accepted care guidelines for acute or chronic disease are on course, in line with what evidence says would be the best management strategy.

However, these forces do not align with the interests of providers, who after all, are essentially paid for each service rendered, whether in the office, hospital or surgery. These people are not paid for patients or the public to be healthy or disease free.

This is why an integrated system like Kaiser (or the countries with universal care and state-owned facilities) run the risk of conflicting goals in their business model. On the one hand, the payor arm wants to keep patients on a long-term low intensity in demand for provider services; on the other hand, they need to keep the clinics and hospitals open, and to keep doctors, nurses fed. Unless the provider staff share in the retained earnings of the payor, the integration has a strategic challenge to meet.

Physicians who adopt EMRs or EHRs, or who are asked to implement Medical Homes, need to be given ways in which their interests are aligned with those of patients and payors, and not simply at an altruistic or ethical level. Even if the providers are employed by payors.

EC