As the Trump administration tries to invalidate the Affordable Care Act in the courts and progressive Democrats promote “Medicare for All,” the battleground appears set for yet another politically driven war over healthcare policy. But there is no need to divide the country over an issue in which we all have a common stake. The non-political path to dramatically improving American healthcare simply requires the key players — healthcare providers, insurance payers and regulators — to focus on delivering value for all healthcare.
All Americans, regardless of their politics, likely agree healthcare is far too expensive and quality of care is not as high as it should be. The United States spends about $10,000 per person each year (PDF) on healthcare, compared to an average of just $4,000 in other advanced economies. Yet in spite of our heavy spending, life expectancy in the U.S. is nearly two years below (PDF) that of comparable nations.
These problems are a direct result of our fee-for-service system in which providers are compensated for the quantity, rather than quality, of care. To achieve the triple aim of healthcare — reduced costs, better outcomes and greater patient satisfaction — we must rapidly accelerate the shift to a value-based system in which quality, not quantity, is the key metric determining compensation. Providers should be rewarded for delivering better health outcomes and keeping patients healthy.
The transition to value has been moving at a snail’s pace, even though the Centers for Medicare and Medicaid has been incentivizing health systems to make the switch. Our survey of more than 200 healthcare organizations, providers, payers and regulators in the U.S., as well as some overseas, found 60% have not taken a step toward value-based healthcare in the last two years.
Here’s what must happen to accelerate the shift to value:
Care should be organized around the needs of the patient. This means a more interdisciplinary team-based approach in which doctors closely coordinate with caregivers, families and insurance carriers, particularly in complex cases. When health providers work in integrated practice units, rather than siloed specialties, it’s possible for patients to see multiple doctors during the course of one visit. Greater convenience and better communication promote a more proactive approach to medicine that can prevent illness.
Providers should aggressively adopt new technologies, such as telemedicine devices that monitor vital signs, blood glucose levels and medication compliance, all in the patient’s home, to make care more efficient and economical. Every doctor should have easy access to her patients’ complete electronic health record (EHR) to improve care coordination. This means EHR vendors must make their systems interoperable.
The most powerful tool we have to transform healthcare is our capability to mine data for insights that will make care more effective. So large provider organizations should diligently collect patient data to help determine when specific tests and treatments are valuable and when they are wasteful. Meanwhile, the rapid decline in the cost of genomic sequencing is opening a new frontier in the ability to utilize data to pinpoint potential health problems. As providers learn of their patients’ genetic mutations, they can prescribe medications and recommend lifestyle changes that may prevent or at least delay disease.
By employing big data analysis, harnessing smart technologies and making medical practices as patient-centric as possible, health providers will be invested in a proactive model of care that can reduce the prevalence of serious illness and its high cost of treatment.
The faster health systems embrace these tenets of value-based care, the sooner we’ll resolve many of the problems afflicting American healthcare. These key principles are agnostic to the current political landscape and will help us move beyond the unproductive, ideologically charged legal battle over the Affordable Care Act and toward the ultimate goal of a health system that works for all.
Bret Schroeder is a healthcare expert for PA Consulting. He leads PA’s Healthcare Growth Strategy team and is responsible for helping organizations leverage technology to improve business performance. He has over 20 years of business strategy and operations experience and has an extensive background working with healthcare payers, providers and associations. Bret has advised both public and private organizations not only in Colorado, but also in the U.S., U.K., Middle East, and Asia.
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