Quintuple Aim Prevented By Design
Quintuple Aim has become the next latest and greatest focus in health care
- improving the patient experience,
- improving the population health,
- reducing the per person cost of health care,
- enhancing the experience of the workforce, and
- improving health equity.
THE BIG QUESTION: HAVE OUR DESIGNERS IMPROVED QUINTUPLE AIM?
And the answer is best expressed as HELL NO for your choice of 40 to 50% of Americans depending upon just how bad you want to make it.
The designers across CMS, states, and private insurance really do not understand most Americans most behind. They also continue to fail to understand delivery team members and practice environments.
Patient experience
Financial designs relegate most Americans to fewest/least team members and deficits of workforce across 2 or 3 county areas. The coding was smoothed for adjacent counties to illustrate this. The design requires more travel. More barriers are harmful not helpful.
My take on caregivers in the 2621 counties lowest in health care workforce is that the health care designs completely blow them away. There are concentrations of elderly, poor, disabled, chronic diseases, worst behaviors, worst employers, worst health plans to go with least supports.
Population Health
The impact of the financial design is severe on the 40% of the population in 2621 counties lowest in health care design. The health care designs pay 15 - 30% less. Concentrations of the worst public and private health plans magnify the impacts that kill jobs, economics, access, experienced team members, social determinants and health care leaders in the community.
There is little question that the design result is the opposite of population health. It can be difficult to tell since these counties already have the worst outcomes and drivers of outcomes which designs certainly appear to be making worse.
The employers also tend toward worst environments. Deficits of access compound the problems.
Reducing per person cost of health care
Once again the focus on overutilization via cost cutting causes harm to these vast regions that have been permanently shaped lowest in access - where underutilization and inappropriate utilization is made worse by cost cutting/overutilization focus. Designers cutting costs where care is most lacking - should be held accountable.
New CMS wrinkles include another 2.8% cut in payments and the 3% Medicaid waiver - which is actually a 3% cut in Medicaid payments. These are not good choices, especially in practices and Community Health Centers with concentrations of the worst paying plans.
The damage from this waiver can be particularly difficult to understand as we all want to help with food and housing, but the impacts on delivery team members are multiple and all harmful to those already most stressed. They must set up resources, spend extra time with patients, and then follow up and revise. There is no end to the added duties.
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Enhancing the Experience of the Workforce
Clearly higher turnover/turnover costs are seen in health care in these counties. Toxic environments follow the financial design as shaped by
a) government/plan cost cutting and
b) employers.
There are two directions for health care employers shaped by their situation and choices
a) choice of profit is a choice to abuse those who deliver the care.
b. Employers forced into survival mode - also make choices that abuse those who deliver the care.
Health Equity
Message to CMS Medicare Medicaid HCFA HHS leaders - it is best not to mention health equity if you are a major cause of inequity by health care design. The magnitude of your spending sets up massive potential for inequity.
Sadly, CMS votes 1.4 trillion a year against distributions of funding, workforce, jobs, leadership, and drivers of outcomes.
Voting for most lines of revenue and highest payments where workforce is most concentrated will do that. Relegating most Americans to half enough basic health access workforce will do that.
CMS behavioral leaders publish articles about mental health solutions - solutions that are required because designers have set up the problems such as 23.5% of the mental health workforce and 15% of psychiatrists in 2621 counties with 40% of the population and 45% of mental health need.
It gets worse. Performance based designs discriminate against providers who have the audacity to serve populations most behind. Not only do you get the worst financial design with numerous deficits and patient complexities and deficits of resources, you get penalized more.
The assumption that counties behind are not growing - is wrong. They are the fastest growing as CMS et all designs away their health care. Meanwhile where the population is slowest growing the designs send more dollars, workforce, services, and new ways to harvest CMS dollars.
There is very little hope for the 2621 counties. The financial design has long suppressed the better employers with their better health insurance to bail out public plans. Recruitment and retention of better employers is required and is denied by design.
45% of complexity in 40% of the pop with just 25% of each basic workforce is made less effective by less than 20% of spending in each basic, by design.