Not sure how this all works out in the payment system. Moat family practice and primary care offices run on thin margins with nasty overheads. How does a clinic pay for refrigerators an iPads or other SDOH? Who pays the 3rd party Ombudsman manage pt first care? And also, we frequently have pts demand referrals to specialist or demand specific high costs meds or high dollar imaging tests. It's serous work to talk them down. Sometimes it doesn't work. Therefore, defining quality in primary care is very difficult. No simple formula and can't be simple based on A1c scores, BP numbers and vaccine rates. SODH can all crush those numbers for a doc.
All excellent points. The full risk primary care practices are receiving $1,000 per Medicare Beneficiary per Month vs. DPC getting $50-$150 per patient per month. More than enough $$ to pay for SDOH in full risk practices. Ombudsman fee would be required to come out of part of the $1K per month. These are far from perfect suggestions. Appreciate you watching.
Very thoughtful article and great analysis by Dr EB. There has to be a balance- Too much FFS mentality is not good (like unnecessary procedures), Too much VBC mentality is not good either(restricting healthcare). Incentives drive behaviors- so as a physician it should always be 'patient first'. thank you for this video
I will tell you what SCAN has in place and why they understand VBC deeply. People, patients want to be at home and have their care being managed by the Health Plan that follows through with everything. SCAN looks at the bigger picture, addresses the SDOH with this Team based approach. They also have their own team of In Home Support Staff (IHSS) that visits patients at home. The State of CA asked them to participate in a combined Medi-Medi benefit called “Cal MediConnect” SCAN said NO we already have our IHSS program that is successful. The STATE does NOT. Anyway, I have huge respect for SCAN and happy that I worked there, I learned a lot.
Thank you for the video. I believe that pre-HMO insurance days were more focused on the Pt. and their needs and amt. of time necessary for care, not incentives, metrics, and bonuses. Pt.s received care, with fewer RTA's, ER visits, and prescriptions. I am happy that SDOH is being reviewed now, as it is always such an important piece to healthcare and Pt. stability in treatment.
Noooo…. VBC is the new variety of Medicare Advantage. The insurance companies realized that the medical profession was in mutiny over the scheme that took the money out of health care funds and moved it into the pockets of insurance companies….to the total detriment of patients. Now, this new VBC is the next step….the insurance companies have this new scheme to share these ill gotten money with the physicians practices. How do you think they will make money? By not spending that money on patient care. Advantage with “profit sharing”. The worst part about this is…..when a doctor orders a procedure or test…advantage and HMOs will deny the care. After multiple appeals (records show an average of 2 appeals to get the denial overturned) the patient eventually gets the procedure/test/ whatever. BUT…under VBC…the order is never written. The doctor has financial incentive to NOT make that order. So, how do you appeal that? Insidious! How will you even know what the doctor should have ordered? This is just another way for corporate America to drain health care dollars for profit. Awful. Like I said….this will ensure that any patient who is informed will never trust their doctor again.
This is so right on for Pregnancy. Happy Late Black Maternal Health Week. Purchasers why don’t we have value alignment in Maternity Care? Are you ok with having the worst outcomes in the industrialized world? There are plenty of provider networks made of Midwives, OBs, MFMs and hospitals working together for better outcomes. Employers and Medicaid you have a fiduciary duty to demand better results. Are you ok with the current state? Demand better ! #cmmi #onc #hitech
I love your videos for my master's program ❤️ 💕. My 3 favorite F word is "free", "food" and "fun.. you give me 2 of them free and fun.. Love you enthusiasm.. 😂.. animated lecture 👌
It seems like this is the video that should be titled: arguments against value based care. What happened to the Nuremberg Code? This really seems quite frightening to me, because it seems like it takes the power out of my hands to fight for myself. Seeing how drug companies already don’t want to cover name brand drugs, if I have a good doctor, and a some perseverance on my part, I can still get the medication I need for my condition. Value based healthcare puts me at the mercy of a limited scope of medical professional teams who might share my values? I can appeal to a patient advocate, but whose side are they truly on?. Will they truly advocate for me, or will it be more like a present day hospital based patient advocate? Im not cheerleading our current system, but calling something value based doesn’t suddenly inspire morals and integrity to those corrupt individuals who broke our current system. If this system negates the authority of the Nuremberg Code, the trade off could be much worse than our present system!
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During Covid we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died. My father was admitted to the hospital by his doctor (not for Covid), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice. When my wife had Covid our PCP was utterly useless. She qualified for monoclonal antibodies, but he would not refer her. He would even prescribe a cough suppressant. We were on our own! Me, my wife, and our fathers were not alone. Until the crimes of Covid are reconciled, one would be a fool to allow a system to be put in place the which puts you at the mercy of these evil people in the medical establishment. I’m fully aware not all doctors and nurses are bad. I’ve met many good ones over the past 4 years, but until those bad doctors, nurses, politicians, and health authorities are put on trial for the crimes they committed, I will never be able to trust the medical establishment!
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During Covid we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died. My father was admitted to the hospital by his doctor (not for Covid), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice. When my wife had Covid our PCP was utterly useless. She qualified for monoclonal antibodies, but he would not refer her. He would even prescribe a cough suppressant. We were on our own!
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During the pandemic we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died. My father was admitted to the hospital by his doctor (not the virus), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! The last four years we were constantly being lied to by the medical authorities regarding the origins, treatments, and vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect following the first shot, he was given the second shot. A month or so after the second shot he died. My father was admitted to the hospital by his doctor, but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
@@ahealthcarez and salary is affected by them? Like in your Medicare Value-Based Payments video My income is based on re admission rate? Hospital acquired conditions? Getting patients to do early intervention like weight loss program seeing a dietician smoking cessation clinics Recommending a social psychological program that is early intervention?
at a fundamental level, the same type of problem occurs in fee-for-service or in value-based care, which is the principal-agent problem. whenever you have an agent making economic decisions on behalf of another principal stakeholder, there *will be* conflicts of interest. you can't rely on any code of conduct or clever administrators to make those conflicts disappear. so i like the RRT idea you have here. but i tend to favor the idea that there should be money allocated for patients to proactively make such decisions. if pressing that button loses money for the hospital and you give it to employees of that same hospital, there will be pressure not to press it. if you give it to the patients themselves, then it's a free button to skip the line and go around the system. if you make it a limited resource that patients can spend, they can decide for themselves if they really need to see that specialist or have that extra bed day despite the calculation made by their value-based care provider.
@@ahealthcarez one would want a doctor who is well paid. The idea of restriction on creative doctor and independent thinking is population health based thinking where as all real medicine happens at personal level. I.e we doctors have to learn the science and use the knowledge and experience and personalize solutions. That rather very hard with the current model. I.e we have to move away from Mass medicine mindset and change to N=1 approach. I watch and love all most all of what you preach but that one recommendation is not the one I will ever support. I am hoping that you would hopefully update that in the future as you see that that recommendation will just produce burnout and reduce enthusiasm to solve the patients problem....one at a time... #removingbarrierstohealing
I imagine your ideas regarding outcomes-incentivized pay, utter transparency and 'for thee but not me' suggestions go over like a lead balloon in provider populations, lol. I am one of those annoying service user policymakers, 25 years at the public mental health table in Colorado. The fiscal argument I use against VBC or VBR is that EXACT thing; especially true if you do not put complex outliers first & foremost, because they then morph into "high utilizers" who suck capitated managed care systems DRY. (I put "high utilizers" in quotes because I think the term, "system failures" is more accurate & puts the onus where it belongs but then no one will understand who I mean) Of course, in carved out behavioral health, your system fails will eventually be absorbed into corrections or at the morgue so there is not a lot of accountability for failure, and the entire industry had to attract & maintain the walking wounded in order to keep the capitated wheels rolling, shuffling people into lifelong treatment for bumps in life's road - they had to! - so the outcomes focus is on those folks, the bad divorce or difficult pet death set. This is not what that specialty was carved out for, not the intent of the design. I remember in the late 80's when the dual-eligible "high utilizers" were responsible for over 90% of Medicaid spending in the public mental health industry; it is over 50% today, still unacceptable. Anyway, I can't imagine a more brilliant illumination of your theory than psychiatry! From the subjective diagnostics to the hit or miss prescribing practices, there is hardly any medical system that screams "individualization!" more loudly. It is the most costly silo to skimp on, one that can bring down the whole farm when neglected, and I will tell you from the streets, it ain't working to pound exquisitely sensitive, complicated psychiatric outliers into tiny little best practices holes.
@@ahealthcarez Oh, gosh! THANK you for creating such interesting & on point videos! I just found you; I am happy. I am just your run-of-the-mill angry crazy person. I happen to have a CYP2D6 problem & can not metaboloze psych drugs; I literally lost 37 years of my life crawling all over Denver, raving & ranting & peeing on myself. Not to mention costing the state an absolute boatload of money! It really puzzles the heck out of me why outliers are NEVER discussed in VB conversations. You should look at those utilization data - it is horrifying and so easy to target.
Value in putting patients first? Won't happen in a market based system. Profit is the priority. The patient is simply a means to reach quarterly goals. The rest is window dressing to give the illusion of care.
Actually it does happen the thing is Like the doctor said it's quality/ cost Quality naturally increases cost The health care system is made up of two teams Those that think of increasing quality and putting patients first And those that have to decrease costs and increase revenue so that the first team can work on quality Can't have one without the other
@@sanadbenali6993 Quality takes time (and) money. These institutions are wedded to a economic model (capitalism) that demands economic cuts as a baseline fundamental and racing patients through in a production line manner. Cutting cost while increasing value and keeping the patient first is utterly futile. It's like jumping through a unending series of hoops trying to appease to financial pariahs.
![Megan Thee Stallion - Mamushi (Remix) [feat. TWICE] [Official Audio]](http://i.ytimg.com/vi/5c0_u9PsrsQ/mqdefault.jpg)
Not sure how this all works out in the payment system. Moat family practice and primary care offices run on thin margins with nasty overheads. How does a clinic pay for refrigerators an iPads or other SDOH? Who pays the 3rd party Ombudsman manage pt first care? And also, we frequently have pts demand referrals to specialist or demand specific high costs meds or high dollar imaging tests. It's serous work to talk them down. Sometimes it doesn't work. Therefore, defining quality in primary care is very difficult. No simple formula and can't be simple based on A1c scores, BP numbers and vaccine rates. SODH can all crush those numbers for a doc.
All excellent points.
The full risk primary care practices are receiving $1,000 per Medicare Beneficiary per Month vs. DPC getting $50-$150 per patient per month. More than enough $$ to pay for SDOH in full risk practices.
Ombudsman fee would be required to come out of part of the $1K per month.
These are far from perfect suggestions.
Appreciate you watching.
Good Lord, $1K a month? are those like high risk pts? still not wort dealing with all the MC B.S. for the money. @@ahealthcarez
Very thoughtful article and great analysis by Dr EB. There has to be a balance- Too much FFS mentality is not good (like unnecessary procedures), Too much VBC mentality is not good either(restricting healthcare). Incentives drive behaviors- so as a physician it should always be 'patient first'. thank you for this video
Thank you for watching and for your comment!!
I will tell you what SCAN has in place and why they understand VBC deeply. People, patients want to be at home and have their care being managed by the Health Plan that follows through with everything. SCAN looks at the bigger picture, addresses the SDOH with this Team based approach. They also have their own team of In Home Support Staff (IHSS) that visits patients at home. The State of CA asked them to participate in a combined Medi-Medi benefit called “Cal MediConnect” SCAN said NO we already have our IHSS program that is successful. The STATE does NOT. Anyway, I have huge respect for SCAN and happy that I worked there, I learned a lot.
Super! Thank you for sharing.
Thank you for the video. I believe that pre-HMO insurance days were more focused on the Pt. and their needs and amt. of time necessary for care, not incentives, metrics, and bonuses. Pt.s received care, with fewer RTA's, ER visits, and prescriptions. I am happy that SDOH is being reviewed now, as it is always such an important piece to healthcare and Pt. stability in treatment.
VBC is the modern HMO
In many ways… Yes.
Noooo…. VBC is the new variety of Medicare Advantage. The insurance companies realized that the medical profession was in mutiny over the scheme that took the money out of health care funds and moved it into the pockets of insurance companies….to the total detriment of patients. Now, this new VBC is the next step….the insurance companies have this new scheme to share these ill gotten money with the physicians practices. How do you think they will make money? By not spending that money on patient care. Advantage with “profit sharing”. The worst part about this is…..when a doctor orders a procedure or test…advantage and HMOs will deny the care. After multiple appeals (records show an average of 2 appeals to get the denial overturned) the patient eventually gets the procedure/test/ whatever. BUT…under VBC…the order is never written. The doctor has financial incentive to NOT make that order. So, how do you appeal that? Insidious! How will you even know what the doctor should have ordered? This is just another way for corporate America to drain health care dollars for profit. Awful. Like I said….this will ensure that any patient who is informed will never trust their doctor again.
This is so right on for Pregnancy. Happy Late Black Maternal Health Week. Purchasers why don’t we have value alignment in Maternity Care? Are you ok with having the worst outcomes in the industrialized world? There are plenty of provider networks made of Midwives, OBs, MFMs and hospitals working together for better outcomes. Employers and Medicaid you have a fiduciary duty to demand better results. Are you ok with the current state? Demand better ! #cmmi #onc #hitech
Thank you for watching and sharing your thoughts.
I love your videos for my master's program ❤️ 💕.
My 3 favorite F word is "free", "food" and "fun.. you give me 2 of them free and fun..
Love you enthusiasm.. 😂.. animated lecture 👌
Super! Thank you for watching!!
Point 4c is BEYOND excellent.
Thank you for watching and for your feedback.
It seems like this is the video that should be titled: arguments against value based care. What happened to the Nuremberg Code? This really seems quite frightening to me, because it seems like it takes the power out of my hands to fight for myself. Seeing how drug companies already don’t want to cover name brand drugs, if I have a good doctor, and a some perseverance on my part, I can still get the medication I need for my condition. Value based healthcare puts me at the mercy of a limited scope of medical professional teams who might share my values? I can appeal to a patient advocate, but whose side are they truly on?. Will they truly advocate for me, or will it be more like a present day hospital based patient advocate? Im not cheerleading our current system, but calling something value based doesn’t suddenly inspire morals and integrity to those corrupt individuals who broke our current system. If this system negates the authority of the Nuremberg Code, the trade off could be much worse than our present system!
Thank you for sharing your thoughts.
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During Covid we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died.
My father was admitted to the hospital by his doctor (not for Covid), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
When my wife had Covid our PCP was utterly useless. She qualified for monoclonal antibodies, but he would not refer her. He would even prescribe a cough suppressant. We were on our own!
Me, my wife, and our fathers were not alone. Until the crimes of Covid are reconciled, one would be a fool to allow a system to be put in place the which puts you at the mercy of these evil people in the medical establishment. I’m fully aware not all doctors and nurses are bad. I’ve met many good ones over the past 4 years, but until those bad doctors, nurses, politicians, and health authorities are put on trial for the crimes they committed, I will never be able to trust the medical establishment!
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During Covid we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died.
My father was admitted to the hospital by his doctor (not for Covid), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
When my wife had Covid our PCP was utterly useless. She qualified for monoclonal antibodies, but he would not refer her. He would even prescribe a cough suppressant. We were on our own!
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! During the pandemic we were constantly being lied to by the medical authorities regarding the origins of the virus, treatments, and the vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect after the first shot, he was given the second shot. A month or so after the second shot he died.
My father was admitted to the hospital by his doctor (not the virus), but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
@@ahealthcarez I’m curious as to whether you read my comment. The arrogance of the medical community to expect us to trust them with more power over our health is obnoxious and tone deaf! The last four years we were constantly being lied to by the medical authorities regarding the origins, treatments, and vaccines. My father in law was essentially murdered by a vaccine. He was coerced into taking it, and despite suffering an adverse effect following the first shot, he was given the second shot. A month or so after the second shot he died.
My father was admitted to the hospital by his doctor, but instead of starting him on his treatment immediately, they let him sit in the ER for several hours. He ended up going into cardiac arrest. He was revived, but after two weeks despite the neurologist, ER doctor, and his nurse all recommended he continue treatment with a trach and peg, when we went to sign informed consent the ICU doctor nurse on duty that day pushed for palliative care. We were lied to by one of the nurses when she told us he may not live through the night. That evening the attending nurse and head nurse both confirmed they were 99% sure he would live through the night. The lies continue all the way to hospice. Despite the fact my father had improved to the point he was able to say a few words. The hospital released him to hospice.
Very Helpful!
Thank you for watching.
Blitzing the office that would be draconian
Thank you for watching.
What's the variable component in suggestion 1 examples please
Based on performance: eg. B-blocker, ACE/ARB, Statin in Diabetics with CAD.
@@ahealthcarez and salary is affected by them?
Like in your Medicare Value-Based Payments video
My income is based on re admission rate?
Hospital acquired conditions?
Getting patients to do early intervention like weight loss program seeing a dietician smoking cessation clinics
Recommending a social psychological program that is early intervention?
Well said👏🏽👏🏽👏🏽👏🏽
Thank you for your feedback.
at a fundamental level, the same type of problem occurs in fee-for-service or in value-based care, which is the principal-agent problem.
whenever you have an agent making economic decisions on behalf of another principal stakeholder, there *will be* conflicts of interest. you can't rely on any code of conduct or clever administrators to make those conflicts disappear.
so i like the RRT idea you have here. but i tend to favor the idea that there should be money allocated for patients to proactively make such decisions. if pressing that button loses money for the hospital and you give it to employees of that same hospital, there will be pressure not to press it. if you give it to the patients themselves, then it's a free button to skip the line and go around the system.
if you make it a limited resource that patients can spend, they can decide for themselves if they really need to see that specialist or have that extra bed day despite the calculation made by their value-based care provider.
Thank you for watching and sharing your thoughts. Reason why competition and choice are so important… to help address the principal-agent problem.
I beg to defer with your suggestion #1
I think most doctors in America disagree with my first suggestion. Thank you for watching.
@@ahealthcarez one would want a doctor who is well paid. The idea of restriction on creative doctor and independent thinking is population health based thinking where as all real medicine happens at personal level. I.e we doctors have to learn the science and use the knowledge and experience and personalize solutions. That rather very hard with the current model. I.e we have to move away from Mass medicine mindset and change to N=1 approach.
I watch and love all most all of what you preach but that one recommendation is not the one I will ever support.
I am hoping that you would hopefully update that in the future as you see that that recommendation will just produce burnout and reduce enthusiasm to solve the patients problem....one at a time...
#removingbarrierstohealing
I imagine your ideas regarding outcomes-incentivized pay, utter transparency and 'for thee but not me' suggestions go over like a lead balloon in provider populations, lol. I am one of those annoying service user policymakers, 25 years at the public mental health table in Colorado. The fiscal argument I use against VBC or VBR is that EXACT thing; especially true if you do not put complex outliers first & foremost, because they then morph into "high utilizers" who suck capitated managed care systems DRY. (I put "high utilizers" in quotes because I think the term, "system failures" is more accurate & puts the onus where it belongs but then no one will understand who I mean) Of course, in carved out behavioral health, your system fails will eventually be absorbed into corrections or at the morgue so there is not a lot of accountability for failure, and the entire industry had to attract & maintain the walking wounded in order to keep the capitated wheels rolling, shuffling people into lifelong treatment for bumps in life's road - they had to! - so the outcomes focus is on those folks, the bad divorce or difficult pet death set. This is not what that specialty was carved out for, not the intent of the design. I remember in the late 80's when the dual-eligible "high utilizers" were responsible for over 90% of Medicaid spending in the public mental health industry; it is over 50% today, still unacceptable. Anyway, I can't imagine a more brilliant illumination of your theory than psychiatry! From the subjective diagnostics to the hit or miss prescribing practices, there is hardly any medical system that screams "individualization!" more loudly. It is the most costly silo to skimp on, one that can bring down the whole farm when neglected, and I will tell you from the streets, it ain't working to pound exquisitely sensitive, complicated psychiatric outliers into tiny little best practices holes.
Wow. Thank you for your thoughtful comment.
@@ahealthcarez Oh, gosh! THANK you for creating such interesting & on point videos! I just found you; I am happy. I am just your run-of-the-mill angry crazy person. I happen to have a CYP2D6 problem & can not metaboloze psych drugs; I literally lost 37 years of my life crawling all over Denver, raving & ranting & peeing on myself. Not to mention costing the state an absolute boatload of money! It really puzzles the heck out of me why outliers are NEVER discussed in VB conversations. You should look at those utilization data - it is horrifying and so easy to target.
Wendell Potter exposed the industry is one fell swoop.
Yes he did.
@@ahealthcarez We greatly appreciate your work to solve these issues.
Value in putting patients first? Won't happen in a market based system. Profit is the priority. The patient is simply a means to reach quarterly goals. The rest is window dressing to give the illusion of care.
Thank you for watching and sharing your thoughts.
Actually it does happen the thing is
Like the doctor said it's quality/ cost
Quality naturally increases cost
The health care system is made up of two teams
Those that think of increasing quality and putting patients first
And those that have to decrease costs and increase revenue so that the first team can work on quality
Can't have one without the other
@@sanadbenali6993 Quality takes time (and) money. These institutions are wedded to a economic model (capitalism) that demands economic cuts as a baseline fundamental and racing patients through in a production line manner.
Cutting cost while increasing value and keeping the patient first is utterly futile. It's like jumping through a unending series of hoops trying to appease to financial pariahs.
@@sanadbenali6993 Dismantling the for-profit healthcare system is the only way.
@@presterjohn1697 that's not actual capitalism it's actually anti capitalism to increase revenue and cut costs
It's a misrepresentation of capitalism