The changing face of healthcare

I recently came across this article, which is aimed at American physicians:

Getting ready for emerging care models

Like it or not change is coming to healthcare. The government, employer groups and other purchasers of healthcare are demanding higher quality and lower costs in the delivery of healthcare. The Affordable Care Act of 2010 started this evolution and whatever you call it -- value-based purchasing, accountable care, patient-centered healthcare, etc. -- it is taking root and starting to grow rapidly.

[...]

To get an idea of what you should be thinking about, let’s look to a healthcare market where these “new” healthcare delivery models are the norm and have been in place for years. One such market is in the Netherlands, where 90 percent of demand for care is generated in the primary care setting and providers (private) are paid a lump sum based on conditions and work in integrated care networks.

In the Netherlands today, 99 percent of physicians use a computer, 97 percent are Internet-enabled, 90 percent store all types of health records electronically, 84 percent receive lab results electronically, and 26 percent exchange data electronically with other providers – all benchmarks that the United States aims to achieve in the next 3-5 years. The international standards used in the Netherlands are consistent with U.S. conventions, as HL7 and ICD-9 are used in healthcare and ICD-10 is being adopted. Also, as in the United States, Holland does not have a dedicated health ID number or “smart card” for patients that some European countries have adopted but which are not relevant in this country. In these respects, the Dutch market is extremely similar to the U.S. market. This market is where our own company history started, and where our care collaboration and disease management solutions have matured.

Here is what you need and why
To participate in a value-based delivery model you must be willing and able to coordinate and collaborate on patient care with other ambulatory providers; the goal is to render the right amount of preventive care, avoiding health complications and resulting in better patient care with lower attendant costs. Once this mind shift has taken root -- a very different and, for some, a difficult way of thinking -- you need the basic tools and capabilities to engage in care coordination. These tools must:

Enable you to store patient information electronically. This does not have to be the typical full-blown EMR that legacy vendors have been marketing. These EMRs were developed in the fee-for-service model to optimize billing and reimbursement and resemble digital renditions of paper records. Not to mention they are expensive to acquire and maintain even when they may be subsidized by the ACO. Instead, you need a platform that is designed for the new delivery model focused on optimizing patient care, with a workflow that fits your practice pattern. For more on this see the 2010 PCAST Report titled "Realizing The Full Potential of Healthcare Information Technology to Improve Healthcare."

Enable patient-centric care, including making sure that patients receive reminders for preventive services through multiple channels based on their personal profile.

Support the care team network, allowing all providers, physicians, facilities, etc., involved in treating particular patients to share relevant information through collaborative and coordinated care.

Manage patients proactively.

Be able to generate electronic referrals.

Be a cloud-based solution. Cloud-based solutions require little or no local IT support and investment. This is really important for the average physician practice. Also the pricing level and payment structure with predictable cash flow more closely matches the size of the practice.

To distill down these capabilities into specific tool sets means you should expect to have the following: an EHR; a care collaboration/coordination solution; and the ability to exchange electronic referrals. The key in selecting the right solutions for your practice is to pick one with the right workflow for your practice. The solution(s) must be cloud-based so you can avoid the costly hassle of purchasing and supporting local software installations, which is expensive and not your core competency. If you do not have these capabilities you either might not be a candidate to participate in an ACO, clinically integrated care delivery network or PCMH, or the ACO will force you to use their solutions.

You should expect the ACO to provide other required solution capabilities such as clinical decision support (CDS), analytics, population health tools, health information exchange platform (HIE); reporting tools, etc. These are expensive solutions tailored for a large organization to manage and support. [...]

It goes on to describe the current inefficient, entrenched ways of doing things, and how they are going to be forced to rapidly change, as has happened in many other industries (It has an embedded link to an article in Forbes).


Also see:

Have Smart Phones to do Medical Work
     

Have Smart Phones to do Medical Work

And save us lots of time and money, too:

Visit NBCNews.com for breaking news, world news, and news about the economy

The doctor being interviewed talks about waste in the medical industry, and suggests that a third of all drugs prescribed are unnecessary or even harmful.

He demonstrates how a Smart Phone can be used to replace many costly and time consuming tests that waste time and money. Yet I wonder how far he will succeed with this medical phone apps technology? It would cut into the profit margins of those who are heavily invested in the old way of doing things.

 http://www.nbcnews.com/id/21134540/vp/50582822#50582822  

Rawanda Healthcare: Lessons for us all?

Rwanda's Historic Health Recovery: What the U.S. Might Learn

[...] Over the last ten years, Rwanda's health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda's economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

The rest of the world, wealthy countries and well as poor, can learn from Rwanda's rapid rise.

[...]

Rwanda achieves exceptional results not from how much money they spend on health, but from how they spend it. A recent article in BMJ, led by Farmer, examined World Health Organization data and sought to identify why Rwanda developed so rapidly, and to clarify the lessons for other countries. Rather than a single cause, the authors identified a series of interconnected factors that contributed to the country's turnaround.

First and foremost, credit belongs to the government of Rwanda's centralized planning. In 2000, the Rwandan government created a plan, called Vision 2020, to develop economically into a middle-income country over the next two decades. Dr. Agnes Binagwaho, Rwanda's Minister of Health, explained that "health is a key pillar of our development" and that without improving health, they will never alleviate the country's poverty.

[...]

While the specific context of Rwanda cannot be replicated, Dr. Farmer contends that Rwanda's focus on evidence-based policy, central planning, health systems, and equitable access to care should be heeded both by countries looking rebuild their health system and those with strong systems already in place. "In our commitment to understanding complexity," said Farmer, "we need to not forget that there are generalizable lessons to delivering care that are not acceptable to ignore."

While the United States still exceeds Rwanda in most traditional health metrics (such as life expectancy), and its hospitals and medical care surpass those in Rwanda, U.S. health outcomes still falter because too many patients fall through the cracks. The U.S. health system relies too heavily on doctors and hospitals to provide care. A growing body of research suggests that more frequent health care use and higher costs may lead to poorer health.

Farmer believes that, if the United States extended health care into the community like Rwanda, care for chronic diseases would markedly improve while costs would over time drop. Indeed, community-based pilots in the United States have proven effective in settings from inner-city Boston to rural Mississippi. [...]

There is much more in the full article. Lots of food for thought.
     

My battle with Mothra; what it cost me

I posted a while back about How my Battle with "Mothra" put me in the ER. Well, I finally got the bill.

I expected it was going to cost around $200. I was wrong. The actual cost is $391.00. Quite a lot for squirting a little bit of saline solution into my ear to flush it out.

I suppose I shouldn't complain too much; I'm still alive to tell the tale, unlike poor Mothra. Thank goodness for Medical Savings Accounts. The next best thing to Godzilla.

Health Insurance and Medical Expenses

Have you ever considered that health care costs are so out of control because of insurance? How could that be? John Stossel shows us how:

Our Crazy Health-Insurance System

[...] You have to understand something right from the start. We Americans got hooked on health insurance because the government did the insurance companies a favor during World War II. Wartime wage controls prohibited cash raises, so employers started giving noncash benefits, like health insurance, to attract workers. The tax code helped this along by treating employer-based health insurance more favorably than coverage you buy yourself. And state governments have made things worse by mandating coverage many people would never buy for themselves.

Competition also pushed companies to offer ever-more attractive policies, such as first-dollar coverage for routine ailments, like ear infections and colds, and coverage for things that are not even illnesses, like pregnancy. We came to expect insurance to cover everything.

[...]

But insurance is a lousy way to pay for things. Your premiums go not just to pay for medical care but also for fraud, paperwork and insurance-company employee salaries. This is bad for you and bad for doctors.

The average American doctor now spends 14 percent of his income on insurance paperwork. A North Carolina doctor we interviewed had to hire four people just to fill out forms. He wishes he could spend that money on caring for patients.

The paperwork is part of insurance companies' attempt to protect themselves against fraud. That's understandable. Many people do cheat. They lie about their history or demand money for unnecessary care or care that never even happened.

So there is a lot of waste in insurance -- lost money and time.

Imagine if your car insurance covered oil changes and gasoline. You wouldn't care how much gas you used, and you wouldn't care what it cost. Mechanics would sell you $100 oil changes. Prices would skyrocket.

That's how it works in health care. Patients don't ask how much a test or treatment will cost. They ask if their insurance covers it. [...]

(bold emphasis mine) That is why insurance should be for catastrophes and accidents, not every little thing people need. It's trying to use insurance to pay for EVERYTHING that has made costs go completely out of control. Paying for your health insurance is getting as costly as making mortgage payments, and it needn't be so.

I made a simple visit to my doctor in June. I've only just recently received the bill for that visit. In the interim, I've gotten several statements from the insurance company, each covering some small aspect of the visit. I don't see doctors often, yet I've got files filled with such things. The paperwork generated, and the labor costs associated with it, are ridiculous. I could have paid him right then and there, but it's not ALLOWED. Clearly, changes are needed to reduce the bureaucracy created by insurance companies and third party billing.

Stossel makes some good suggestions in that regard. It's worth reading the whole thing, it's a short article and gets right to the point.