Engineering processes to make over a hundred million one-on-one encounters more efficient and effective has a predictable result: tens of thousands of pages of rules, regulations, incentives, and punishments.
The law of unintended consequences magnifies complexity. Complexity magnifies unintended consequences. The system feeds on itself and everything around it until it is all about the system, not the solution.
A prominent example is using electronic health and medical record systems as a mechanism to reduce costs. The unintended consequence? They made billing under fee-for-service more accurate and easy, increasing costs.
Better solutions require an understanding of the underlying dynamics. A good example is that medicine is less about control than it is about caring.
Empathy and caring cannot be scaled easily, nor can it be productized. It takes time, nurture, evolution, and a practical operational model that is truly patient centered. Patient-Centered Medical Homes, for example, should not merely be about an idealized version of reengineered primary care. They must focus on eliminating waste while strongly engaging patients in a way that can drive short-term medical spend and outcomes. Keeping physicians in touch with external forces and allowing them to manage patient populations in downstream settings is about policy, not process. Prioritizing activities and remuneration that will keep physicians in independent business will drive savings to the system and help fuel a new independent primary-care business model.
Of the critical shortcomings resulting from focusing on process instead of solutions:
• Practices are not getting the data they require to help target their efforts. The payer collaboration and reporting integration that will enhance targeting is missing entirely;
• The support team hired by CMS is totally engrossed in the redesign of internal practice processes rather than educating them on the tactics and strategies to drive reductions in downstream spend (95 percent of Medicare spending occurs outside of the primary-care office); and
• Practices are not being drawn into discussions regarding medical neighborhood models that could lead to geographic, localized high-performing physician networks that might exert marketplace leverage for price transparency and price competition with hospitals and specialists to further bend the curve.
Opportunities are being lost, and that needs to change.