Physician Led Reform Vs Collaborative Reform

1
Physician Led Reform Vs Collaborative Reform

• Wells Shoemaker MD
• Medical Director
• California Association of Physician Groups, PMG
  Santa Cruz

2
Some Peculiar Plan Beliefs

• Consumers actually care about brand
  differentiation
• Practicing doctors care about branding
• HEDIS Plan scores have local relevance
• Patients and doctors believe any Plan is
  trustworthy or truly motivated for QI

3
Realities from Local Perspective

• Plans are all considered difficult partners by
  groups, distrusted by individual Drs.
• Groups regard our patients not by Plan label, but
  by PCP. Not a Blue Cross patient, but a Dr.
  Weber patient.
• Patients are members of our population, using our
  own resources. This is Good.
• Constant migration and discontinuity

4
Silos of CareLocal and State

• Integrated group vs. IPA
• HMO vs. PPO vs. Medicare vs. Medi-Cal etc.
• Solo, small group, large group
• Affiliated vs. Unaffiliated
• Safety Net, FQHC /-, politics and mission
• Public Health
• Cognitive vs. Procedural
• Hospital based vs. office based

5
Common Ground

• No single agency, even a huge Blue One, has
  enough money, influence, or expertise to change
  health care delivery and quality over a
  population.
• There is more than enough money, expertise, and
  zeal in the system to do so.

6
Local Example

• Santa Cruz CountyHealth Improvement
  PartnershipALL players, executive level, every
  month
• Choose common ground issues for community wide
  effort. Compete elsewhere
• Dramatic progress with spin offs

7
State Example

• Breakthroughs in Chronic Care Program
• Health Plans
• Purchasers
• Lead Medical Groups CAPG
• Lumetra and State Agencies
• Pharma
• Composite Clout is Considerable

8
Tools

• Incentives work if aligned. Thanks, Blues.
• Delegated model is logical bridge
• Combination of peer awareness then pressure PLUS
  realistic redesign teaching AND economic
  facilitation requiredwe have the first two.
• Need the best creative minds of Plans, Purchaser,
  Groupstrust, networks

9
More Collaboration Coming

• ICSI is a model that worksculturally
• CA has the pieces on the table
• Charismatic leaders at the table
• CAPG focus changingdelegated model matches Plan
  needs for local footprint
• Need executive commitment to go from pilot
  curiosity posture to mission

10
The Answer is Yes

• We have abundant experience with pilots, small
  populations, and regions to know that quality of
  care can be changed in rather short order.
• Is it possible? That is no longer in question.
  The question is the scale and the rateand the
  commitment.
• Since the answer is Yes, we have an ethical
  mandate to do it . The public will not tolerate
  excuses.

11
What would that look like?