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The ‘illusion of value-based medicine’

 

Alexandra Tien, M.D., a family physician, writes in The Providence Journal about “the illusion of value-based medicine”:

“In this new world, the catch phrase ‘value-based’ medical care is frequently mentioned, but it is hard to utter this phrase with a straight face when one considers that such value-based reimbursement models only apply to physicians.”

“We have capitalism in all its ugly excess when it comes to the rest of the medical industrial complex, i.e., big insurance, big pharma, health information technology, etc. All that this so-called value-based care really represents is a way to transfer health-care costs from insurers to physicians, who are already squeezed.”

“Neither should patients expect more value under these new models, since the value specified therein can only be demonstrated by additional busywork for the physician, further limiting time for patient care. Patients thinking that ‘value’ will be measured in more face time with doctors will be sadly mistaken. Indeed, given the extra administrative burdens, the opposite may well occur.”


Happy and unhappy about N.C. Medicaid change

raleigh

Downtown Raleigh, the capital of North Carolina.

Providers worry and insurers are happy about North Carolina’s move to Medicaid managed care. Physicians and hospitals assert that the change, assuming that the Feds approve it, will reduce services for poor people and unfairly reduce money for providers.

Republican Gov. Pat McCrory  last month signed legislation to move the state’s $12.7 billion Medicaid program serving 1.9 million residents from fee-for-service payments made directly to providers to capped payments to managed-care insurers. But the Centers for Medicare & Medicaid Services must approve the change before it goes into effect.

The bill lets  the state award three statewide managed-care contracts to insurance companies and authorizes up to  12 regional “provider-led” entities  to  sign agreements with the state to manage Medicaid populations.

The governor said :“Under the current system, we wait until people get sick to provide care and pay for tests—not outcomes. This new system will focus on keeping people healthy and delivering care where it makes the most sense for patients. We’re going to accomplish this reform by paying providers based on improving patients’ health—not how many services patients receive.”

Providers  had  backed changing the program, but rejected turning to private insurers as the main vehicle for cost control, reported Modern Healthcare. “We’re concerned about the draconian ways (plans) try to control things,” said Robert Seligson,  chief executive of the North Carolina Medical Society, told the publication: “Instead of a value-based medicine approach, they focus on financial returns. Wall Street is what drives them.”


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