|By Savannah Tranchell|
Long before the bitter debate over the federal law, most of which was upheld by the
Insurance based on employment -- you could lose it if you're too sick to work -- and the fee-for-service system --paying doctors and hospitals for doing more stuff, even if it's the wrong stuff -- have created incentives that push in all the wrong directions, many say.
Determined to reverse course, hospital executives, clinic administrators and physician groups have been doggedly pursuing ways to lower costs by changing the incentives that drive the health care industry.
"We all agree, I think, that the current fee-for-service model has all the wrong incentives in it," said
The work to curtail costs and improve quality has required an alliance of strange bedfellows: insurers, government officials and private providers, in the past often found on opposite sides of a negotiating table.
No one thinks it will be easy to wrestle the lumbering, fragmented and tradition-bound health care industry into a form that rewards quality and efficiency -- not quantity -- of care.
These local leaders are buoyed by some early successes.
One collaboration between hospitals around the state and the
The goal, said
Other public-private collaborations, some convened by Gov.
Insurers and providers have worked together, rejiggering the typical payment model to shift incentives toward keeping people healthy instead of just running up bills when they're sick.
One ongoing agreement between major insurer
Some other changes under way seem small -- Swedish asked cardiologists to agree on a single vendor for catheters and other hardware about four years ago. But Brown, the CEO, said there are "enormous savings" there, as well as benefits to patients.