Public Private Partnerships
Transformation and reform of the U.S. healthcare system is possible, but one major obstacle stands in the way: pharmaceutical giants, large hospital systems, medical device manufacturers, and other healthcare special interests spend hundreds of millions of dollars each year lobbying the government for favorable treatment.
The sheer scale of money devoted to influencing policy is staggering.
The counterarguments raised by healthcare incumbents have been heard and thoroughly noted. Everyone understands that innovation carries inherent risk. Even the transformational entrepreneurs leading this work recognize they may need to pivot or modify their business models to mitigate those risks. We all know that innovation disrupts the status quo—and that disruption can be painful. In some cases, it can even be fatal to outdated business models.
But none of that compares to the cost and pain of doing nothing.
We are asking several healthcare incumbents—specifically insurance companies—to participate in a pilot program that incorporates the key transitional cornerstones described earlier. This pilot would be narrow in scope, focused exclusively on total joint replacement (TJR), yet we believe it could pave the way for meaningful transformation across the broader healthcare system.
The goal of the pilot is simple: prove that Medicare can save significant money on TJR by shifting substantial downside risk to providers. The long-term aim is for this model to become the national standard for Medicare-funded TJR. Based on our data, we believe there is an opportunity to save Medicare hundreds of millions of dollars every year on TJR in the state of Texas alone.
To ensure broad adoption among surgeon providers, we will also need Blue Cross Blue Shield of Texas to establish a parallel commercial program. We believe this program would likewise save Blue Cross Blue Shield hundreds of millions of dollars annually on TJR.
If Blue Cross Blue Shield agrees to participate in this pilot, we will present the details. These will include, but will not be limited to:
A physician and patient-centric model
A substantial shift of financial risk to physicians
Technology enabling physicians to manage that risk, while providing CMS and Blue Cross Blue Shield with real-time access to data
Financial support to help physicians manage downside risk through a reinsurance-backed warranty.