My goodness, how the merry-go-round twirls!
Back in the 1990s, if we didn’t manage population health, we did not manage capitation– at least not profitably! What’s different this time is that all the tools I’d wished we had then, we now have. In fact, we have a dizzying array of them! I believe that there are too many choices– but that’s good for competition.
I made lots of money during the 1990s as did my clients, managing capitation well. I also pioneered bundled payment pricing back then. Now all of a sudden, that’s new and “innovative” too! Meh!
What’s innovative and new is the way we can risk stratify data, analytics and engagement.
I was speaking with one of our interns the other day. He is pursuing a Master’s degree in geomatics. Geographic Information Science and Technology (GIST) enables analysts to address today’s human health, urbanization, and sustainability challenges, among other things, by enabling the view of the world through a spatial lens. This too, is not new. In fact, I learned that in 1854, an English physician, John Snow demonstrated how mapping can be used for epidemiological research. In 1991, I instinctively sensed and tested capitation contracting best practices by executing due diligence prior to accepting capitated financial risk for claims costs by not only reviewing age, gender, and plan design, but also requiring contracting plans to supply me the zip codes of the proposed assigned population. From that data, I dug into census data to determine consumer characteristics of the proposed population. This led me to certain corollaries about how they lived, how they played, how they shopped, how they ate, and previous claims they submitted. I did that without violating HIPAA by asking for two data sets, the second being an ICD-9 report by zip code of the claimant.
While I did this all by instinct and seat-of-the-pants execution in the mid-1990s, it worked.
What it cost my clients was my time. Now GIS technology can assist us in determining where and when to intervene, improving the quality of care, increasing accessibility of service and finding more cost effective delivery modes, while preserving patient confidentiality. At the same time, we can satisfy the needs of the research community for data accessibility. I wrote about it then, in the book you see to the left, published by HFMA and McGraw Hill in 1997. Many of the tests and due diligence best practices for capitated contract were included in the book.
I’m so excited for my new friends in GIST majors. They will be able to track the sources of diseases and the movements of contagions that could wipe out any ACO or integrated health delivery system at financial risk because of an epidemic of flu or another virus, despite the most tightly-controlled case management, care navigation and disease management practices of the network management. IPAs, PHOs, ACOs and others will be able to respond more effectively to outbreaks of disease by identifying at-risk populations and targeting intervention.
Public health uses of GIS include tracking child immunizations, conducting health policy research, and establishing service areas and districts. GIS provides a way to move data from the project level so that it can be used by the entire organization to implement effective campaigns. Doctors and Network Managers will be able to quickly interpret reams of data in a visual and geographic dashboard report that is readily understood using Esri Internet Map Server (IMS) technology. (Esri is an international supplier of Geographic Information System software, web GIS and geodatabase management applications.) This health data can be easily accessed using an Intranet or the Internet. Privacy compliance will be more easily managed through tools that can aggregate health record data at the census tract level so that the privacy of individual patients is preserved through the use of an ArcView GIS query tool. Funny, I had an ESRI tool back in the 1990s too. It was what inspired me to start thinking about how to better predict and stratify my clients’ capitated risk.
So when you speak of the healthcare reform of the Clinton era, and you hear about how everyone lost money, how there were no winners…please, not such a broad brush! A few of us still in the business made a ton of money back then. My second book on this topic was published by international publisher, CRC Productivity Press, an Informa company, in 2012. This book is in both print and digital format. Technology: Gotta love it!
In many areas of the country, my clients’ profits were attributed to why capitation cycled out of favor: The health plans didn’t want to pay us anymore for the upside risk once we learned how to manage it. Dubious? Not to worry, I’ll set up a conference call with some physician clients from back then and you can ask them yourself. They own huge health systems now from the millions they made with capitated risk and population health management tools that were tantamount to rubbing sticks together.
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By the way, my GIS interns would love to help you with a short project. Let us know how we can help.
