Thought that blog headline would generate some level of interest…
Listening to a great new NPR Podcast by NPR called How I Built This. The very first episode tracks Sara Blakely and her innovation and development of Spanx. After significant effort in finding a supplier, getting a patent, and reserving a unique name, this former fax saleswomen was able to get very early traction through Neiman Marcus and Oprah. Against the advice of friends, she decided to go to the masses via QVC. Appearing herself, she proceeded to sell 8,000 Spanx in 5 minutes! Her rational was quite simple, every women regardless of socioeconomic status wants to use her product. Her self-made billionaire success story is remarkable, inspiring, and instructive to #physicaltherapy. Everyone, regardless of insurance type needs to use our product as well.
In many markets, Medicaid is truly being innovative. Several non-profit systems are globally captivating medicaid direct from their state or in combination with a third party payor. Some entrepreneurial healthcare companies are taking 100% risk with thousands of combination medicare/medicaid lives contracted through Medicare Advantage carriers. By way of reminder, these private insurance Medicare Advantage carriers get paid more by CMS to deliver the very care that Uncle Sam delivers themselves. The total risk concept is that there is enough margin in a payor’s administrative cost to subcontract entirely from a payor and take the risk for providing the entire care of a patient and still make a decent profit margin. These initiatives are most common in high density neighborhoods or markets where a critical mass of lives is available to scale and manage through primary care, internal medicine, and cardiology. Do they work? In most cases they do simply by intrusive medical management, strict and rational refusal of excess utilization, eliminating regulatory constraints that simply add cost without adding value, and understanding that total spend is the critical measurement and not silo cost.
For physical therapists, great opportunities are out there to work at the highest use of our licenses in managing overall musculoskeletal spend. Imagine becoming the primary musculoskeletal manager for highly complex patients. You get paid directly for your services and then a percentage of the overall save in total spend at the end of the year beyond a baseline for the prior year. Said differently, the PT is now the caregiver and the gatekeeper. Any takers? Is a PT really willing to say no to a patient in discomfort that wants an MRI, medication, injection, or referral to a specialist? Can a PT discern without undue bias in this conflict of interest position where by saying no the contribution to savings benefits economically the PT? It is easy for us to be critical of other providers and payors who are in this situation but mainstream PT’s have never really been in this situation. Are we really strong in our evidence or would we be willing to bend as patient advocates and compassionate, caring PT’s? We should also keep in mind that patients in this environment are the most medically complex with significant co-morbidities. Arguably, a PT would have to be better trained and experienced to work in this environment. Only time will tell if PT’s are willing to immerse themselves in this level of care and risk.
Physical therapy, like Spanx is ready for the masses. Are we willing to appear on QVC and sell our own wares?
Thoughts?
@physicaltherapy