The relative success of PCP capitation, and the failure (lack of market uptake) of episode based payment for me points to an opportunity. Nascate has developed a powerful Attribution Engine that develops insights into existing member/patient to provider relationships and can be used to support accountability and payment. These relationships insights are based on behavior rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.
The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.