An interview with Leslie Michelson in in today's WSJ. My wife pointed it out to me immediately this morning. She told me, "You need to read this". Mr. Michelson has created a company, Private Health Management, which assists the 1% in navigating the health care system. The mission of this company is to summarized:
Strictly defined, Private Health isn't part of the growing phenomenon known as concierge medicine, where doctors charge a retainer for more face-time and personal attention, and often take their practices off the commercial and government payment grid. Private Health isn't an insurance company either and maintains no contractual or financial relationship with its doctors. "We don't buy access," Mr. Michelson says. A large part of what Private Health does is simply match patients with physicians, which isn't as obvious as it sounds. "People do not know how to choose doctors. It's one of the most important things you can do to promote your own health and that of your loved ones, and it's: 'My friend's cousin's relative went to Dr. Smith, and he was terrific.' Well, how do you know he's terrific?" So Mr. Michelson built a series of proprietary algorithms to distinguish "the few who are the very best" from "the many who are very good," based on "the factors that predict excellence."However, I think the key statement comes somewhat later in the interview:
"As the biomedical revolution took off," Mr. Michelson says, "there should have been a counterbalance of somebody taking the position of the general contractor, the manager, and investing in the systems, the technologies and the processes to keep up." But the organization of medicine as an industry didn't change. So the health-care delivery system, to the extent it qualifies as a system, "has no quality control, no integration, no coordination." Doctors "tend to operate in an independent and isolated way, and even specialists who've been treating the same patient for years and years typically never, ever speak to one another."http://online.wsj.com/article/SB10000872396390444620104578008182459803120.html?mod=WSJ_Opinion_LEADTop
The business plan of Private Health Management is to basically supply an uncovered service to people who can pay for it. In that sense it is similar to concierge care or provision of lasik surgery or botox injections. The bad news it is not covered by insurance. However, the good news is that it is outside the constraints of the present day third party payment system. I would say the trade off is more than worth it if you can come up with the dough.
The sad truth is that despite all of the talk about rewarding coordination of care, there is no explicit and consistent payment of time devoted to such activities within the current payment structure. There may be a few ongoing experiments which are likely to disappear when their grants dry up. If the public were to wait for the current players in health to development of such a key element of care, it would never happen. As a precondition for development, the mainstream players would insist it develop as part of the current payment system. I am afraid that it would quickly be co opted by those who fare well under the current payment structure which rewards expensive and fragmented care.
Ultimately, for optimal care the care coordination piece must be embedded locally. Someone needs to be in charge. Someone other than the patient or their family needs to be the general contractor.