The most important thing happening in healthcare
If you ask 20 people in healthcare what is the most important movement transforming our industry, you might get 20 different answers.
- Direct primary care!
- Price transparency!
- Patient Centered Medical Home!
- Social determinants of health!
Why has the healthcare industry changed more in the last 5 years than it did in the 15 years before that? It’s because we are finally starting to get financial incentives aligned. We are upending the traditional fee-for-service framework, and patients are benefiting.
For POs, these tectonic shifts in the payment landscape can be more unsettling than exciting. That doesn’t change the fact that payment reform and ever-changing financial models are the new normal.
I think the transition to risk is the most important thing happening in healthcare, and I’m here to help.
I’m Adam Lorton
I started my healthcare career as a hospital pay-for-performance analyst. I was teaching providers about the CMS readmissions program. I warned that if our patients came back to the hospital after hip and knee replacements, we’d be in trouble. We could lose tens of thousands of dollars!
Trying to understand the bigger picture, I became a hospital profitability analyst. The picture started to come into focus. Reducing readmissions was the right thing to do for patients, but not for hospital finances! We got paid for every readmission. The CMS readmissions penalty was a drop in the bucket compared to our profit margin on readmissions.
Even though I heard a lot about ‘population health’, actions spoke louder than words. I saw a lot of investment in operating rooms and not a lot of investment in primary care.
It seemed like everyone was talking about Population Health, but they were perfectly content with the status quo.
Eventually, I found myself doing contract work at a PO. To my surprise and delight, I was suddenly among people who were actually transforming healthcare. They had a network of primary care providers working to keep their patients out of the hospital. They were using data to target the highest-priority patients. They wanted me to tighten up their data strategy, so they’d be ready for the risk-based contracts they knew were inevitable — and I was excited to dive in.
I decided POs are my kind of people!
If the transition to value is the most important thing happening in healthcare, and if POs are the ones driving that change the hardest, then POs are who I’m going to serve.
Transforming healthcare is hard work. From what I’ve seen, there’s no easy fix. But I think it’s worth fixing the hard way.
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