An open letter to @commonwealthfnd and @CPR4healthcare:
I published an article here on Tuesday suggesting that a report issued by the Commonwealth Fund was deeply flawed. As a courtesy, I tweeted the post on Twitter to the Fund for your reaction.
Imagine my surprise when you quickly seemed to walk away from the report.
Ok, maybe I got it wrong. It wasn't a Commonwealth Fund report after all. You just helped fund it. But, after all, it was consistent with policy prescriptions offered by the Fund.
So, last night I tweeted a bit more:
And also sent a direct message to the CEO of the Fund:
As a reminder, here is a repeat of my direct disagreement:
Here's my take--and I am open for correction: I know of no substantive analysis that shows that the clinical variation that exists in the United State and across the world, across all methods of payment and institutional delivery systems, is tied to the rate design used to pay for care. I know of no substantive analyses that shows that the use of methods included in the "reform" definition offered by the Commonwealth Fund have made a difference, over time, in the health care costs incurred in various regions.
I continued:
I do know that a substantial portion of society's health care costs are spent on an incredibly small percentage of the population. Rather than trying to redesign an entire system, why not focus on improving case management of that small percentage? Rather than trying to transform an entire payment regime into a risk-based system that has incredible complexity--in terms of allocating that risk across and within a provider network--why not simply pay cognitive specialists more, so they can spend more time with patients and keep the patients away from expensive tests and hospital admissions?
There is no monopoly on insights in this field. I again invite correction. Will you respond? Will you stand by your work? Will you engage in debate? You are not alone in your views. But there are many who disagree, too. This is too important to let stand unanswered.
I published an article here on Tuesday suggesting that a report issued by the Commonwealth Fund was deeply flawed. As a courtesy, I tweeted the post on Twitter to the Fund for your reaction.
Imagine my surprise when you quickly seemed to walk away from the report.
So, last night I tweeted a bit more:
Here's my take--and I am open for correction: I know of no substantive analysis that shows that the clinical variation that exists in the United State and across the world, across all methods of payment and institutional delivery systems, is tied to the rate design used to pay for care. I know of no substantive analyses that shows that the use of methods included in the "reform" definition offered by the Commonwealth Fund have made a difference, over time, in the health care costs incurred in various regions.
I continued:
I do know that a substantial portion of society's health care costs are spent on an incredibly small percentage of the population. Rather than trying to redesign an entire system, why not focus on improving case management of that small percentage? Rather than trying to transform an entire payment regime into a risk-based system that has incredible complexity--in terms of allocating that risk across and within a provider network--why not simply pay cognitive specialists more, so they can spend more time with patients and keep the patients away from expensive tests and hospital admissions?
There is no monopoly on insights in this field. I again invite correction. Will you respond? Will you stand by your work? Will you engage in debate? You are not alone in your views. But there are many who disagree, too. This is too important to let stand unanswered.