Latest / CareTalk: Healthcare. Unfiltered. / Why Hospitals Keep Defaulting to Medicare Logic

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Why Hospitals Keep Defaulting to Medicare Logic · CareTalk: Healthcare. Unfiltered.

• 0:06
  David Snow: That's a really, really good point.
• 0:08
  David Snow: And, uh, you know, I ha- I have a different way of talking about this, um, and that is that moving from fee-for-service to value-based care is like crossing a chasm of death.
• 0:19
  David Snow: Imagine yourself walking on this rickety bridge, this gorge down below, nothing but rocks, and you'll definitely die if you f- if that bridge breaks in the middle.
• 0:29
  David Snow: Uh, and as you're, as you're making the journey, um, it gets harder and harder as you get to the middle of the bridge because when you're 50% value-based care and 50% fee-for-service, you're schizophrenic.
• 0:44
  David Snow: They're completely different ways of managing a patient, to your point.
• 0:48
  David Snow: And doctors aren't gonna say, "I'm gonna treat this patient this way.
• 0:50
  David Snow: I'm gonna treat that patient that way because of the way I'm reimbursed." So it's, it's really hard, uh, to, to create the c- company-wide muscle memory about running your business in a, a value-based care world when you're only 10% value-based care and 90% fee-for-service.
• 1:12
  David Snow: So to me, the tipping point is when I'm more than 50% value-based care, I'm committed, and I've gotta finish the journey.
• 1:20
  David Snow: I'm not gonna run back to the other side.
• 1:24
  David Snow: So, you know, if I s- go to the public policy level, when people mess around with these value-based models as people are trying to learn and create muscle memory, every time we do it, we risk them running back to fee-for-service.
• 1:40
  David Snow: Uh, so we need some stability in these programs so that we can c- get through this learning curve that we're going through.
• 1:47
  David Snow: We're literally retraining generations of healthcare, uh, providers to think about patient care, uh, and outcomes differently than they historically have thought about it.
• 2:03
  David E Williams: You know, I remember-- I'm thinking about now the role of the federal policy versus state and, and you've talked a lot about the commercial payers and what they can do.
• 2:11
  David E Williams: I remember way back when, uh, when Charlie Baker was running what was then Harvard Program- Mm-hmm ... you know, before he became governor of Massachusetts.
• 2:18
  David E Williams: They did this program.
• 2:19
  David E Williams: They were really trying pretty hard with, uh, whatever the flavor was of, uh, you know, pay-for-performance or value-based care.
• 2:26
  David E Williams: And- Right and they said, you know, they-- When they're, they were one of the biggest players or maybe even bigger at Blue Cross at the time.
• 2:31
  David E Williams: But, you know, big, well-known, nationally ranked- Yep ... top one or two players.
• 2:36
  David E Williams: And what they said is they went to the hospitals, and then when they went to see what the impact was, basically the hospitals say, "Well, my biggest customer is Medicare.
• 2:44
  David E Williams: And so what I do is I just take, uh, what you've given me, whatever it is, and I just sort of convert it into, like, Medicare equivalent, and I just do whatever I'm doing for Medicare for you." What is the interplay these days between- You know, the federal side in particular, and what's happening in the commercial space
• 3:00
  David Snow: Yeah, so I, I, I know Charlie Baker, and back then I was, I was at US Healthcare back then.
• 3:07
  David Snow: And, uh, you know, when docs say they, you know, they convert it to the thing they know, it's because they don't have the precision analytics.
• 3:19
  David Snow: Today, our platform has the ability to monitor and manage and project actuarially how you're doing in each and every value ba- based contract you have.
• 3:30
  David Snow: So you can understand what are the levers you pull to perform well or, and optimize your outcomes both financially and clinically.
• 3:40
  David Snow: And so the world is different today than that world that Charlie talked about or that I experienced.
• 3:48
  David Snow: We're so much more precise now.
• 3:49
  David Snow: It's so much more manageable that you don't have to generalize the way you just described.