Russell Branzell on the financial case--or lack thereof--for coordinated care

By Gienna Shaw

Is there a compelling business case for providers to coordinate care with other organizations? Farzad Mostashari, former National Coordinator for Health IT, posed that question to CHIME CEO Russell Branzell (pictured) in a session at the group's annual fall conference last week.  

"I think the answer's 'no' right now," Branzell said.

"Most of our hospitals would argue that they still work within a confined patient population," he said, adding that most health information exchange is internal. "The challenge there is whether there's value. And what we're hearing is not for the hundreds of thousands of dollars or millions of dollars being paid by our members."

Mostashari agreed. "Sometimes free is too costly if you don't have a business incentive--or maybe a perverse incentive--to coordinate care."

There are two issues, Mostashari said. One is whether HIEs are providing services at a reasonable cost and the second is whether the hospitals have an incentive to coordinate care and share information. But "you can't blame the HIEs for not having a business case if there's no business case for care coordination," he added.

"[I'll] let you in on a big secret," Mostashari continued. "The policy intent of CMS is 100 percent to do whatever it takes to change your business incentives so that coordinating care for the patient is profitable to you and not coordinating care will be unprofitable."

Hospitals and health systems should plan their budget based on the fact that readmission and other penalties are going to increase, and that there will be incentives for accountable care and lowering cost of care. 

Mostashari made similar remarks about the financial disincentives for practicing preventative medicine, as FierceHealthIT previously reported. Although coordinated care supports the common value of making people better, it runs counter to every other force, including the bottom line.

"So we may have a fantastic ability to reduce unnecessary asthma hospitalizations and if the hospital loses money doing the right thing, it can't survive," he said.

Russell Branzell on the financial case--or lack thereof--for coordinated care