Thirty Years discussed on POLITICO's Pulse Check


So when you say they wanted to match their performance of the star ratings better what he meant well the star rating system is a roughly fifty measures of performance based payment system it is literally the biggest experiment in performance based parent payment on the planet right now and those measures are very aggressive and they the bar keeps rising every year and only when you really own physicians can you really have any hope of getting them to perform better against these many measures so you know right now in star ratings roughly half the score is determined by the member experience or the the experience that the patient has going through the healthcare system and you know when you consider that star ratings and the member experience in particular is really driven not by the health plan staff which only touches the beneficiary eight to ten times a year on average but those beneficiaries have twenty six counters in the outpatient setting every year so ran out of the gate their doctors are two to three times as influential on those performance measures as the planet self is then it really makes sense to own these practices and not to be lost on the fact that if a hospital system buys that practice they're now charging medicare two to three times as much as a hospital based provider so that's why i said it was an arms race because there is very much a race going on certainly in the case of united in its optum subsidiary which has been buying up doctor's groups like it's going out of style it really is designed to control the means of production and get these guys to practice the way you need them to it's it's no accident that the highest performing plans under the star rating system are kaiser permanente who own all of their providers in what we call staff model fair for decades and decades that's been their model it's it's been interesting to watch because there has been a trend time and again that doctor's groups need to be part of some bigger system hospitals bought them up thirty years ago that experiment largely failed the hospital sold them.

Coming up next