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PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

This article explores the story of Paul Hannum, who tragically passed away due to a ruptured appendix. It highlights the financial suffering of the uninsured and discusses rising economic inequality, racial disparities, unnecessary procedures, and variation in healthcare spending. The article also examines the similarities between HMOs and ACOs in terms of their purpose and challenges in the healthcare system.

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PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

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  1. PHYSICIANS FOR A NATIONAL HEALTH PROGRAM 29 EAST MADISONSUITE 602CHICAGO, IL 60602TEL: (312) 782-6006WWW.PNHP.ORG

  2. The Uninsured

  3. Hannum thought he had a stomach flu or food poisoning from bad chicken. On Monday, his brother saw him looking ashen and urged him to go to the hospital. "He had a little girl on the way," his older brother Curtis Hannum said. "He didn't want the added burden of an ER visit to hang on their finances. He thought 'I'll just wait,' and he got worse and worse." By the time Hannum got to the hospital and was admitted to surgery, it was too late. Paul Hannum, 45, died on Thursday, August 3, 2006, from a ruptured appendix. His daughter, Cameron was born two months later.

  4. Financial Suffering Among the INSURED

  5. Rising Economic Inequality

  6. Persistent Racial Inequalities

  7. Racial Disparity in Access to Kidney Transplants

  8. Rationing Amidst a Surplus of Care

  9. Unnecessary Procedures

  10. Variation in Medicare Spending: Some Regions Already Spend at Canadian Level

  11. Half of Americans Live Where Population Is Too Low for Competition A town’s only hospital will not compete with itself Source: NEJM 1993;328:148

  12. ACOs:A Rerun of the HMO Experience?

  13. Why the ACO/HMO Concept Resonates Proliferation of redundant high tech facilities and useless, even harmful interventions Neglect of primary care, public health, prevention, mental health Lack of teamwork Widespread quality problems need system solutions Inadequate public accountability

  14. HMO and ACO:Similar Definition, Purpose, and History Diagnosis: FFS and “fragmentation” Rx: Invert FFS incentives, shift insurance risk to doctors; “protect” patients with report cards; consolidate providers into larger entities Same vague definition: network of providers “held accountable” for cost (via capitation) and quality (via report cards) Shared poster child: Kaiser Permanente Both initiated by politicians advised by key policy entrepreneurs (HMO: Paul Ellwood; ACO: Elliot Fisher)

  15. HMO-ACO Logic FFS is the problem; capitation(shifting insurance risk) the solution. But . . . small clinics and hospitals can’t bear risk, so consolidation is necessary. Shifting risk creates incentive to deny care, so report cardsare necessary.

  16. Predicting the Impact of ACOs • Track record of HMOs • Results of Medicare’s Physician Group Practice Demonstration, 2005-2010 • Evidence on tools ACOs likely to use: • prevention and disease management • “care coordination” • report cards and P4P schemes • electronic medical records

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