Why can't I ever think of this stuff?   In recent weeks we have all heard of the "ambulatory care ICU."  CHS has announced that their trademarked "Hybrid Health" model has been installed at Vanguard.  We have also learned in the last couple of years about the medical home, the nurse navigator, and the care system coordinator.  Add these names to concierge medicine, ACOs, narrow networks, and value-based purchasing, and we will need a new lexicon of health care terms in order to have a conversation about programming. 

I wish I could think up a couple of good names and acronyms to start using.  I do take credit (or blame) for dubbing the provision of on-site workforce health programs the generic title of "employer-managed health."  Go ahead and re-use this, no trademarks on this one.

I know that in my references above I am missing a couple these new buzz words, but the point is that these are all just new descriptions for old ideas.  We know what medical care and health care should look like and how it should perform, but it doesn't.  So, we come up with new  terms ("programs") to try to inspire action and create a vision of what we need (as opposed to what we are actually getting).

In visiting with a number of people at conferences this past month, they discussed the concept of "risk contracting" with vendors. This is a term, whose use in on-site services agreements, I would really like to clarify in order to avoid its misuse.   The employer who is self-funded is "at risk" for the entire health care spend; and, an HMO or an indemnity insurance company can be "at risk" for the cost of medical care for an entire, specified population.  However, when we use the term "risk contracting" to describe vendor relationships, we need a new term!  This is performance contracting, and it does not transfer the risk of the health care cost to the vendor.  It only puts a portion of the fees paid to the vendor in a bucket that can then be withheld if performance on mutually agreed upon goals is not met.  Call it an incentive, call it a penalty, but don't call it risk or risk-sharing with the employer.

I get the same feeling some people might have when fingernails are scraped across a chalkboard when the term "risk" is used in this way.  Bonuses and penalties are not "risk" when the word is applied to the health costs of a population.  We can ignore ACOs for now, but the vendors in this space are competing on their merits and putting their fees in a contingent performance pool.  I respect that - just don't equate this with the true risk that the employers are accepting as they write checks for ever-increasing health care costs for their employees and their beneficiaries.

  

Sincerely,