SecureChoice: The Long Term Vision
• Everyone has coverage for inpatient and chronic illness care through a Universal Coverage Pool, or UCP
• UCP is a publicly chartered, politically independent, agency pooling risk. It pays directly for inpatient care and covers indirectly chronic illnesses
• Providers such as physicians or hospitals set fees and practice as they choose
• Patients are insulated from the occurrence of significant health problems, but have an economic stake in the value they receive for the care of their problems
• UCP provides bundled payments to new care delivery teams composed of hospitals and independent physicians who collectively agree on governance rules and revenue allocations for episodes of inpatient care
• The payment from the UCP for each episode of care (analogous to Medicare’s DRGs) is based on the resources used by those teams achieving better than average risk-adjusted outcomes for patients
• Teams may charge more than the UCP payments and can pass such excess charges on to patients or insurers
• People choose a primary care practitioner, or perhaps a specialist, to help coordinate care, but not act as a gatekeeper
• Each practitioner selects one of several competing Payment Intermediaries (PI) to handle his or her billing in a low cost, efficient manner.
• The PI working for each primary care practitioner provides each patient with a health credit card to be used for services from any provider
• In processing bills, the PI identifies a patient’s chronic conditions and receives a risk-adjusted monthly chronic illness management payment from the UCP
• Most patients will ask for “wrap around” coverage from the PI to pay for minor acute and other problems, with copayment levels chosen by the patient.
• The net premium for each patient reflects demographic factors, the fees and practice styles of the primary care physician and his patients’ regular providers, net of the chronic illness management payments from the UCP.
• All claims and supporting transactional data will be linked by patient and provider number; privacy-protected versions will be made available in a HIPAA-compliant form for data analysis
• Providers will demand information on their practice patterns and quality to improve the value of services. PIs and independent analysts constantly will try to meet that demand.
• PIs compete for the business of physicians by offering low-cost administration and good information/consulting services. PIs are likely to be new lines of business for existing health insurers as well as transaction experts like VISA