Conflict Or Collaboration

Conflict or collaboration – a choice that faces all stakeholders in the healthcare industry. In a sense, the BHF is one area of collaboration that already exists in the healthcare funding industry. To be sure there are many areas for potential conflict. There is a scarcity of resources in healthcare, and so market participants compete for their share. This is an unavoidable reality. What matters is how these shares of resources are allocated. There are many tensions to keep in balance, and many factors to consider – equity, efficiency and efficacy. Among the models for balancing these tensions are models for conflict and models for collaboration.

Given the tensions and potential for collateral damage, we firmly believe that a collaborative approach is required to improve our healthcare system. While the models are not mutually exclusive collaboration can achieve outcomes that conflict cannot. While schemes and their agents compete on the funding side of the equation, and providers compete for patients, there are many more areas where collaboration is required. Here are some examples.

• Alignment of values

The system revolves around patients, but funders and providers of care do not always agree on how to sustainably look after patients. This leads to much conflict on how funds should be distributed in the healthcare system. However, if there could be a meeting of minds to agree at least in broad terms of an alignment of values, then everyone could work more constructively to achieve good outcomes for patients. We know it’s an idealistic view, but one that is preferable, in our opinion, to the current model of conflict and cynicism.

• Information and data

Healthcare can be a data rich environment. This data can be used to constantly improve the market if used properly. At the moment however everyone holds on to their piece and perspective of the data to the detriment of being able to form a global system wide view of things. If parties in the industry could collaborate more in terms of appropriate data sharing, it would go a long way to alleviate mistrust and tensions, as well as identify opportunities for innovation and improvement. Fraud is an easy example – no one has holistic enough data to pick up fraud systematically. Sure claims data yields some identifiable patterns of behaviour but this only scratches the surface of what could be done with a larger comprehensive dataset. Then there is the perspective of each of the stakeholders – patients, providers, funders, each has items of information the other does not, which inhibits a common view of things that would move us towards more constructive engagement. Healthcare is also something that requires investment and enrichment to yield its full value. Too many market participants do as little as required and waste the opportunities afforded by having powerful information in hand.

• Quality

Quality of care is an issue that should be addressed at a system wide level. Currently there is fragmented dialogue amongst industry participants about what quality of care means, how it should be measured, and how it should be managed. Ideally these discussions should converge so that the industry can agree, with aligned values and appropriately shared data, on how quality levels can be improved. Currently some providers are benchmarked on quality of care metrics in a number of different systems, with some saying they perform well and other saying the opposite. In an environment like this it will be all but impossible to galvanise action on quality improvement programs.

• Coding

Everyone agrees that the state of coding in the industry is a problem, particularly in codes used for billing. While it would not be appropriate to collaborate on setting prices, it makes perfect sense to collaborate on a coding structure and rule system so that the industry can function efficiently when it comes to invoicing and payment. There has been no systematic update to the billing coding schema since 2006, and even before then change was not cohesively managed. There is no compelling reason providers and funders cannot sit and agree on a suitable coding structure. Of course there will be some disagreements along the way, but at least the industry’s invoicing language will be more clearly established. This will go a long way to promoting efficiency, transparency and even eliminating some fraud and abuse.

These ideas are to say nothing of the collaboration opportunities that exist between the private and public sectors of the health system. Currently, the two systems are artificially divided by those that belong to medical schemes and those that don’t. The two systems compete for resources, particularly clinically trained personnel. But there are also significant potential synergies, including management capacity, information technology and systems, and the technical efficiency that drives private sector performance. Many tools, including systems, labour management, procurement, that could significantly assist the public sectors efficiencies and capabilities, already exist in the private sector.

All in all, greater collaboration in the health sector is an effective means of overcoming the many challenges faced. It is the ideal pathway to make progress on the shared accountability and partnership model much discussed at the BHF conference.