[adewinter]

> We pay most doctors and hospitals based on patient outcomes, not fee-for-service.

I'm curious how you convinced providers to bill based on outcome. The metric seems very hard to quantify. How are the outcomes measured? How are chronic conditions handled (e.g. there is no clear resolution to the underlying issue)? Is it a sliding scale or a binary? What happens when a pt visit does in fact involve expensive labs and procedures?

Anyway, congratulations on the launch! I'm a huge fan of anyone trying to improve the healthcare system.

[mjamilkowski]

thallium205 does a great job of summarizing some of the common approaches insurers have used to try and get outcomes to be part of the payment of care delivery. We find that most physicians have not been asked what they consider to be critical outcomes related measurements and benchmarks. We are approaching the physicians we contract with on a basis of partnership rather than combatant, and as a result we have been able to achieve direct physician contracts with value-based metrics and payment components that they are comfortable with. We have the technology and analytics to support the timely and accurate reporting of the emerging experience to support them because quite frankly we are only successful if they are as well. To the point about chronic patients, we support the physicians with extensive care coordination capabilities and analytic support to identify gaps in care, opportunities for broadening the clinical team, and to leverage efficient solutions in telemedicine. We make sure all of the efforts are being communicated back to the primary care and/or specialists so they know what’s going on with their patient when their patient is not in their office.

There is a long way to go however because there is not a lot of trust and there are significant technology barriers. We believe our approach is a breath of fresh air.

[thallium205]

Typically what they do is pay one time for a particular "case". So if you came into the doctor's office consecutively for the same symptoms for a week straight, they'd treat that as an episode of care and pay it as if it's one visit.

Another strategy is to pay a flat rate for seeing a patient. So if they come in once or come in 20 times that month, they get paid the same.

For hospitals what they like to do is pay only on discharge events. So again if you had a 9 day stay vs a 2 day stay, it's the same. They particularly like this because the third party hospitalists and all outpatient care have a difficult time getting the discharge data out of the hospital system resulting in many denials from the payers.

This is by no means an exhaustive explanation of "value" based care.

[mjamilkowski]

Thanks for the great summary!