What might the Amazon, Berkshire and JPM health care joint venture actually do?
25iq.com
25iq.com
Is there something else I'm missing?
[1] https://www.cnbc.com/2018/02/26/full-transcript-billionaire-... (Search for Todd Combs, it'll bring you to the first paragraph talking about the healthcare insurance venture thingy).
Currently, patients don't have the resources or information to assess the quality of their providers. Hospitals with fancy marble lobbies are more likely to be rated as high quality than hospitals with better quality scores but dingier interiors. People think that if care costs more, it must be better
Insurance companies have tried to build narrow networks that exclude high cost hospitals that nonetheless are publicly perceived as high quality, but public backlash, however misinformed, can quash these efforts. One example is UCLA vs BSCA a few years ago
That's not a simple thing to do, especially well, and you kind of implicitly note with your reference to existing quality ratings that lots of people have tried to do it with mediocre results.
most quality standards are not even well known or standardized within the healthcare industry, and there are so many competing interests that it is hard for providers, payers, other stakeholders to align on a standard, useful and enforceable definition of quality. the JV is already insanely visible / high profile without anyone knowing what it does; if they create a quality rating system it will certainly get more attention than any other one created to date
also, amazon / bh / jpm in theory is better aligned with society in terms of what they want out of healthcare: 1) lower cost and 2) customer satisfaction. that group cares about making its employees happy, whereas other stakeholders dont have the same direct accountability to employees / patients: payers are only accountable to patients through the employers they serve, and providers are in theory accountable to patients but in reality more influenced by the health system that owns them or the payer that pays them
But in a broader sense it's really impossible to define objective quality metrics for individual healthcare providers. If a heart surgeon has a high patient death rate is it because she's incompetent or because she takes on the most fragile patients that no one else is willing to operate on? You might think that those differences could be controlled for but in reality there are too many confounding factors and research hasn't even been done to accurately quantify many of them.
The latter issues might be resolved somewhat by the Amazon group; the former is still a concern, but I think there are opportunities to do meaningfully better things
This is just an idea, and I've not done much research on it, so take with a grain of salt: I think patient focused quality measures might be better. For example, look at cohorts of patients with similar characteristics (like in case control studies) who are experiencing a similar health event (knee surgery) and compare providers based on the outcomes these types of patients have. This is something the JV could do, is patient focused, and avoids all the challenges you mention with metrics measuring / managing individual providers (which isn't just hard to measure but demoralizing to docs)
With large enough populations some of those confounding variables even out. But that doesn't help when trying to evaluate individual providers who treat relatively small numbers of patients per year.
Of course in any area all of the local doctors know from subjective experience and word-of-mouth which other doctors are skilled and which are quacks. But none of them will say so publicly, and you can't quantify those opinions.
I think it would make sense to start at the hospital level; provider level probably isn't feasible as you say. Hospitals see enough patients where the sample sizes are pretty big, and they are the main cost driver in healthcare, so rating hospitals by cost / quality could work
The worst thing about hospitals is how they are incentivized to keep quiet about extremely important metrics such as sepsis/staph infection rates, effectiveness at treating certain conditions, etc.
Define quality.
2) Pharmacy at the Amazon warehouse for 90% of most used drugs.
3) Diabetes/endocrine specialist by Amazon as a kiosk in Whole Foods. Most preventable illness in the US is because of sugar over consumption, the rest we can't prevent.
Boom. They just shaved 20% off costs.