North Shore-LIJ and the Cleveland Clinic recently announced a partnership in cardiac care. The networking of North Shore-L.I.J. and the Cleveland Clinic sounds like a good arrangement, and NS-L.I.J. is a quality network. But if employers or insurance companies play a hand in forming integrated provider networks, remember that they are legally obligated (as if they needed any encouragement) to maximize return to their shareholders; that’s why they exist.
Forming integrated networks with care coordinating is, I believe, necessary for advancing quality care in this era. But just as a bulldozer can build or destroy, a network can be a fine thing or can be a tool for restricting care to second-rate (or poorer) providers.
The history of large combinations of heavy-hitting economic powerhouses promoting the interests of consumers is not at all encouraging. If some big systems brag about having one or two big-name providers (“We have the Cleveland Clinic; what more could you ask for!”), there is the danger that it becomes a cover for a restricted network with a lot of low-grade providers. (I’m not suggesting that this is what North Shore-LIJ is doing here. I’m discussing a broader situation.)
What’s the answer? Yes, integrated systems should go forward. But to protect the public, there should be strong regulation. Perhaps more important: since the one who pays the piper calls the tune, we need a system in which the payer is accountable to the public, with rich and poor consumers in the same boat – single-payer health coverage, funded by broad-based revenue based on ability to pay. That’s not going to come from Washington. But New York and some other states that have more progressive politics can enact single-payer at the state level. My “New York Health” bill, A.5389-A, would do that.
