tag:blogger.com,1999:blog-8705432279177203509.post925073624763134695..comments2024-03-19T04:04:16.798-07:00Comments on Budd's Blog: The Emerging Organizational Structure of Health CareBuddhttp://www.blogger.com/profile/03893224951099943306noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8705432279177203509.post-26855256394176523382017-06-02T08:50:18.209-07:002017-06-02T08:50:18.209-07:00Wonderful insightful article but a few points of c...Wonderful insightful article but a few points of correction. The first prepaid plans date back 100 years to the Puget Sound Cooperative followed in the early 1930's by the Texas Teachers group contracting with Blue Cross/Shield. One of the glaring disparities that will exist with any of these organizational structures is still the lack of knowledge of outcomes and quality of care. While the PCMH model does promote a certain consistency of care within its mold, there is as yet no standard of outcome nor metrics for a consumer to determine where the best quality will originate from. While it is desirable to reduce costs thru organizational change, we must consider the patient as the consumer. One of the first questions I ask residents when doing teaching service is how they determine who to obtain consultations from. Frequently they will cite a person well known in the community or someone employed by the hospital. However when I further ask them what do they know about that physicians outcome metrics, they have no knowledge. How can the consumer (patient) obtain optimal care within any of these organizational structures when little is know of outcomes. Once again, once this data is available, it is obligatory that the cost of the care be determined. Only with quality and cost metrics can we move forward from this quagmire of consolidation movements. In addition to the ACO models mentioned, Medicare is currently migrating new large hospital/physician groups into the NexGen ACO with varying degrees of cost sharing models while still failing to address the issue of volume. We are currently being faced with a volume driven marketplace and this can only be stemmed with an eye on the Episode of Care payment system. Perhaps I am rambling a bit onto too many issues and still should focus on health care as a right along with education and freedom of choice. John Ivan Sutterhttps://www.blogger.com/profile/02670902501956779075noreply@blogger.comtag:blogger.com,1999:blog-8705432279177203509.post-74318968835516810212017-05-13T09:57:39.562-07:002017-05-13T09:57:39.562-07:00Thanks, Sue. You are a super model of what a smal...Thanks, Sue. You are a super model of what a smaller practice can do. But, you are super-peds. You exemplify what I was referring to with: "There must be room for the brilliant individualist as well as the consummate leader, and often these shining lights will not fit into the same system."Buddhttps://www.blogger.com/profile/03893224951099943306noreply@blogger.comtag:blogger.com,1999:blog-8705432279177203509.post-939217464578705332017-05-13T06:12:37.731-07:002017-05-13T06:12:37.731-07:00Thanks for this thoughtful post, Budd! As an innov...Thanks for this thoughtful post, Budd! As an innovative, tech-savvy, independent primary care practice who puts patients/families at the center, our practice team will tell you that the relationships formed in small practice can make incredible steps toward the Quadriple Aim!Sue Kressly, MDhttps://www.blogger.com/profile/12250015024382620550noreply@blogger.com