Decision Makers

abe lincolnThe DECISION MAKERS … Are you listening?

Previously in my POSTSCRIPTS for the Consumers and Providers, I mentioned that we have come full cycle to the place where I as a Physician Executive will ask some questions. But this time my comments will be directed to the DECISION MAKERS of our FOR-PROFIT HEALTH CARE INSURANCE MODEL.

Do not consider American health care in transition in the current vacuum in which previous tectonic plates were conceived. In other words, remember the Prime Directive!

NO DECISION MAKER IN THE ROOM SHOULD KNOWINGLY INTERFERE WITH THE NATURAL PROGRESSION OF AMERICAN HEALTHCARE IN TRANSITION

  1. Don’t be the victim of hear-say and evidence of that ilk.
  2. It is like the placebo effect in medical research.
  3. These data results are false
  4. There is an actual hierarchy of proof

USE IT in your deliberations. Bring the recognized experts from all sides of the American healthcare in transition to the table. Get consensus from those involved in the process. The FIRST PARTY-The healthcare providers from Physicians (Primary Care and Specialists) to NP/PAs, Nurses, Therapists, Pharmacists, Ancillary Providers, Hospitals, Long Term Acute Care, Rehabilitation Hospitals, SNFs, Nursing Homes, Medical Technology and even the Pharmaceutical Industry. They all “provide” for the consumers of healthcare. All should get an equal chair at the table.  Not only the Private Sector, but the Public Sector as well. The VA/TriCare and even from the Indian Health Service.

Use this grading system (or one that makes sense to those gathered around the table) and apply it to every argument and document brought to support the pathways being discussed. And yes, looking at what the rest of the civilized world is doing as fgar as health care should be included with appropriate representation. Well respected healthcare organizations such as the Kaiser Family Foundation, the OECD, Commonwealth Fund should also have a seat at the table. And even Medicare for All advocates. You get my drift. If it makes sense to include FIRST PARTY, SECOND PARTY as well as THIRD PARTY representatives, do so.

grading

REMEMBER THE CONFOUNDING VARIABLES

HEALTH CARE COSTS (VARIABILITY)

  • Medical Devices and Technology
  • Pharmaceuticals
  • Health Care Services
  • Patient Compliance
  • Administrative
  • The Costs involved with NOT being able to afford health care coverage

HEALTH CARE REFORM IS NOT DEFICIT REDUCTION!

THE HEALTH INSURANCE PLAN FOR PROFIT MODEL FOR AMERICAN HEALTHCARE IN TRANSITION SHOULD BE CHANGED!

MOVING FORWARD

FIND THE RETURN ON INVESTMENT

return on health care investment - FEATURE PIC

We have discussed the need for consideration of some other sort of model for American healthcare in transition other than the for-profit administrative health care insurance “system” current in effect.  The health care consumer fears loss of access to their physician and the costs associated with this model. The purpose of the Affordable Care Act was to improve affordability and accessibility, oversee, coordinate and govern the many pieces in play.  It did, and it didn’t.  What it did do was stretch across both the private and public payor structure and add more Americans to the roles of the insured. It also brought controversy. And the immediate call for repeal and replacement.

CONSIDER KEEPING THE THINGS ABOUT THE ACA WHICH MAKE SENSE

  • PRE-existing Condition coverage
  • MANDATES FOR insurance coverage
  • Offer 10 ESSENTIAL HEALTH BENEFITS in all coverage
  • Ambulatory care
  • Inpatient Care
  • Pharmacy
  • Preventive Services
  • Rehabilitation
  • Laboratory and X-ray
  • Maternity
  • Emergency Care
  • Mental health Services
  • Pediatric Care
  • Quality Assurance

ACCOUNTABLE CARE ORGANIZATIONS

APPEAL PROCESS

Regardless of the format we select for American healthcare in transition, reward should be based on performance. One model has been the MACRP or Medicare Access and CHIP Reauthorization Act.

pay for performance

By | 2018-12-11T16:06:28+00:00 December 26th, 2018|Categories: Healthcare|Tags: |0 Comments

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