Dennis Y. Fong, M.D.

Paradoxically, complex patients will get better care when they can feel the true cost of it-both the total cost and each component.

POur current system hides these costs so completely that often rational behavior becomes impossible.

Imagine a third-party payor system for cars. Everyone eventually needs a car-just as everyone eventually needs health care. In this system, you can't buy a car directly. You must first see a consultant, who evaluates your needs and decides what kind of car you get-from a simple $20 k subcompact to a complex $300 k van-and how often. Would any rational payor not require a percentage copay that rises with the car's cost? Would it not demand the highest quality cognitive work from that consultant? Yet our health system does the opposite: it imposes copays and deductibles on the clinician's cognitive work, and little or no copays for the vastly larger downstream costs. What's more, payors write threatening letters to fee-for-service clinicians who charge for complex visits more often than a certain low "average".

Health coverage shouldn't treat costs like an earthquake that's 100% beyond anyone's control. Even in complex frailty and chronic illness, many costs can be averted when patients seek early care and when skilled clinicians can keep decompensations contained and prevent the tenuous equilibrium from collapsing. Or when clinicians make regular complex assessments and fine tune management to make the frail patient as well balanced and as resilient as possible.

But that requires patients to feel some share of the real cost—and to patronize clinicians who can truly manage complexity.

The Straight Percentage Copay model https://lnkd.in/gjeYP4iR in my last post enables that.

With Al-enabled tools, patients can be shown-in real time-the clinical and cost consequences of each care path, including the consequences of delay in seeking care. Such transparency will shift behavior faster than any mandate.

Soon, this will generate patient demand for Whole Person Longitudinal Complex Care—and pressure on generalist clinicians to deliver the clinical reasoning that makes it work.