As we are preparing a response to the CMS Healthcare Innovations Challenge, a well known issue is becoming clear. Taking accountability for a geographically completed population is a very different issue than selecting a population of interest based on disease or insurance status or whether they come to your facility. The “triple aim” of better healthcare, better health outcomes and lower cost sounds eerily like the well known slogan of project managers (better, faster, cheaper–can you really expect all 3?).
Consider a hospital and practitioners who wish to achieve excellent outcomes at a low cost in heart failure. The likelihood of success is likely to be very dependent on the selection of a population that is well educated with excellent social support and a high level of compliance. In fact the selection of those types of patients will make the providers look good, while actually making the other providers in the geographic region look worse!
Perhaps this is what explains the paradox in cardiology that many of our best known heart centers (CCF, Duke, Hopkins, UAb) have terrible CV mortality and morbidity rates in their home counties. This won’t be fixed until we are forced to be accountability for the entire population as far as I can see.
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