“I will say what I always say: I, Gunter Wessels, am not for euthanasia, but we've got to do something,” Wessels, a healthcare quality and supply chain consultant and partner in the firm Total Innovations Group, told a roomful of group purchasing executives and vendors on the last day of the conference. Despite their clear discomfort with an unknown future and worry over the financial implication of accountable care organizations, bundled payments, comparative effectiveness and other cost and quality drivers, Wessels pried a hearty laugh from his audience before launching into his spiel about the good that can come from the pain of reform. First on his list of supporting arguments was that a drastic overhaul—not test runs and incremental adjustments—is the only possible way this country can salvage Medicare given the U.S.' demographic realities.
Healthcare reform “will not be defunded even if the Tea Party takes over Congress, because it saves money. It's the smart thing to do,” Wessels said. “The actual solvency of Medicare will be saved,” he added before hitting the crowd with another comical dose of reality. “I'm a Gen Xer, and I'm not worried about it because I have the millennium babies, who are very fertile and will pay for my Medicare. But I'm not comfortable with all those boomers I have to take care of.”
Such demographics and the resulting financial realities mean that while ACOs and bundled payments may be imperfect solutions, they are necessary ones, Wessels said. But to be successful, ACOs will require a good deal of work from providers, GPOs, suppliers and patients alike, he added. The system will require a robust electronic health-records system that serves the needs of everyone from suppliers to end users. It will also require providers to report relevant quality measures, track and trace the cost of caring for beneficiaries, and coordinate primary care across multiple settings.
“It sounds like HMO2, but (payers) are not front-loading risk like in the HMO days,” Wessels said. Providers “get to bill for services all the way along, and at the end, you add it up and if you saved money you get to share in the savings. That's a huge shift.”
Of course, that shift means that providers will continue to duke it out with suppliers in an effort to get their costs down and their operating margins up, but there's nothing new about that equation. So at the end of the day, the unknown may not be so unfamiliar.
Reporter Shawn Rhea, based in New York, covers health technology issues.