Healthcare in 2020: What Should Be Done?

To reiterate a previous blog post, we know Health Care is an important national topic. Also, a federal judge ruling that the ACA is unconstitutional has set the stage for its continued importance.

The ACA is still in place until 2019 when the mandate to have insurance goes away, thanks to the 2017 Tax Bill. Appeals have begun. The Supreme Court will become involved. Health Care will continue to be a hot topic in the 2020 Presidential Election.

So what should happen to our healthcare system in 2020 and beyond?  Here are my suggestions:

ONE COMMON OPERATIONS MANUAL

  • Healthcare should be universal
  • Some forme fruste of “One Party Payor”
  • Combine all administrative function for economy of scale
  • Take the best of existing overlapping health plan options

ONE COMMON POLICY MANUAL

  • Evidence Based Medicine
  • Accountable Care Organizations

ONE COMMON REIMBURSEMENT MANUAL

  • Pay for Performance
  • Risk Sharing

Consider another healthcare model

 

Take the Best of Existing Overlapping Health Plans

WHICH OPTION ~~ WHAT FEATURE?

  • MEDICARE ~~ Tax Structure to Pay for Healthcare
  • MEDICAID  ~~  Means Test Disabled & Children
  • VA   ~~  Government Owned Providers of Healthcare for Special Populations
  • TRICARE  ~~  Overall Model for Operations Manual/Policy Manual

One Common Policy Manual

1.  SOURCE: ACA

COMPONENTS:

PRE-existing Condition 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

APPEAL PROCESS

2.  SOURCE: Evidence Based

COMPONENTS:

  • Grading:
  • 1A – Strong recommendation. High quality evidence. Strong recommendation, can apply to most patients in most circumstances without reservation
  • 1B – Strong recommendation. Moderate quality evidence. Strong recommendation, likely to apply to most patients.
    1C – Strong recommendation. Low quality evidence. Relatively strong recommendation; might change when higher quality evidence becomes available
  • 2A – Weak recommendation. High quality evidence. Weak recommendation, best action may differ depending on circumstances or patients or societal values
  • 2B – Weak recommendation. Moderate quality evidence. Weak recommendation, alternative approaches likely to be better for some patients under some circumstances
  • 2C – Weak recommendation. Low quality evidence. Very weak recommendation; other alternatives may be equally reasonable

 

One Common Reimbursement Manual

SOURCE: ACA

COMPONENTS:

Created the Independent Payment Advisory Board (IPAB)

  • Create savings when Health Care spending reached a certain level
  • Panel has the authority to make payment changes
  • Congress would need a three-fifths super-majority vote to overrule it.

IPAB - Independent Payment Advisory Board

 

 

Pay for performance chart

SOURCE: Pay For Performance

Risk sharing chart

SOURCE: Risk Sharing

 

By | 2019-03-12T09:19:30+00:00 March 12th, 2019|Categories: Healthcare|0 Comments

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