Now come two advocates of bundling who are having second thoughts. They are James Caillouette, Surgeon-in-Chief at the Hoag Orthopedic Institute, and James Robinson, economics professor at UC Berkley, who write in Health Affairs that –
As leaders in the Integrated Health Association (IHA) bundled payment initiative, we shared the same hopes, devoted the same energies, and share the same frustrations with the modest results. We feel it is important to emphasize what we consider to be the initiative’s most important design failure: the lack of engagement and alignment on the part of the consumer. No one will ever reform the U.S. health care system without bringing the consumer along and, indeed, placing consumer choice and accountability at the very center of the reform initiative.
They go on –
We were first and the most enthusiastic participant in IHA bundled payment initiative, sending the hospital’s entire C-suite to the founding meeting with the health insurers. We signed more contracts and treated more patients than any other participant. But we never received the volume of new patients necessary to cover our incremental expenses, much less finance a much-desired expansion.
They conclude –
Our policy focus right now, however, is in encouraging the alignment between consumers and providers through reference pricing, travel medicine, quality reporting, and price transparency.
Well, better late than never! These are precisely the remedies that I and NCPA have been advocating for about 20 years now. But the “health policy community” keeps getting distracted by whiz-bang new slogans like ACOs, bundled payments, case management, and the latest — Big Data! None of these are actually new ideas. They are all just repackaging of the same old ideas that have failed in the past. They all involve some smart guys (or committees of smart guys) telling everybody else what to do.
But, maybe there is hope if even Health Affairs is publishing articles about the essential role of empowered and engaged consumers making good decisions.