Of Mousetraps and Medicare

Added on Jan 17, 2014

There are two ways to build a better mousetrap: tweak the existing model or create a new one.


The best approach depends on the extent of the flaws in the original design. While minor defects can be addressed by improving technologies or adding new features, too much tweaking of a poorly functioning base model can result in a Rube Goldberg-esque product that requires indirect, convoluted means to approach the desired end.


In health care, if Medicare is the mousetrap, it’s time to build a new model. Congressional sponsors of new legislation seeking to improve care coordination for beneficiaries with multiple chronic conditions are attempting to do just that. Their proposal is consistent with the “value agenda” championed by Harvard Business School Professor Michael E. Porter and Press Ganey Chief Medical Officer Dr. Thomas H. Lee.


On Wednesday, January 15, U.S. Senators Ron Wyden, D-Ore., and Johnny Isakson, R-Ga., and U.S. Representatives Erik Paulsen, R-Minn., and Peter Welch, D-Vt., introduced a bipartisan, bicameral bill called the Better Care, Lower Cost Act,which is designed to remove the multiple barriers that prevent Medicare providers from ensuring chronically ill seniors have access to specialized, patient-centered care regardless of where they live.


According to Centers for Medicare and Medicaid Services, 68% of Medicare enrollees have multiple chronic conditions, such as cancer, diabetes and heart disease, and their care accounts for 93% percent of Medicare spending. Additionally, Medicare beneficiaries with multiple chronic conditions represent 98% of hospital readmissions.


The bill proposes setting up a Better Care Program, or a BCP, through which providers could actively target and enroll the sickest patients who would benefit most from specialized, focused care and implement a tailored plan unique to the needs and conditions of each individual. Under the legislation care teams would have more flexibility in where they provide services, including in-home care when appropriate.


Promoting a patient-centered system organized around what patients need rather than a supply-driven health care system organized around what physicians do represents a fundamental strategy change, Porter and Lee wrote in a recentHarvard Business Review article titled, “The Strategy That Will Fix Health Care.”


The proposed legislation is move in the right direction, according to Dr. Lee. “As a country, we must tackle the most challenging aspects of the health care system to reduce patient suffering, improve clinical outcomes and achieve greater efficiency. This proposal catapults U.S. health policy into the realm of care delivery and seeks to remove barriers to better care coordination,” he said. “By organizing clinicians around the needs of Americans with chronic diseases, we have the potential to deliver a better patient experience and outcomes, while reducing costs.”