Healthy Living A Path To Profound Healthcare Transformation
In my terminal post—Think Small together with Don't Rock the Boat—I harshly criticized the strategy that says: “Since our healthcare organization focuses much to a greater extent than on lucre than the value patients receive, nosotros should hit real picayune to increment the value of attention delivered to patients because our electrical flow organization punishes providers (hospitals, clinics together with practitioners) financially for delivering high-value care.” I argued that instead of accepting the electrical flow nutty system, we should, instead, focus on rapid together with radical (profound) transformation, so that providers are genuinely rewarded for delivering cost-effective attention inward a high-value, patient-centered healthcare system. This is no slow task, however, since those benefiting financially from the electrical flow organization combat against profound modify (as demonstrated past times previous efforts at reform), which puts providers amongst adept hearts together with ideals inward a real precarious together with unfair situation.
H5N1 high-value patient-centered healthcare organization non exclusively delivers acme character care, but it does it efficiently together with at a adept cost (i.e., cost-effectively) consistently over a person’s entire lifetime. This is real dissimilar than the healthcare organization nosotros have got today. H5N1 typical example: Greater profits larn to providers who are wasteful (over-test together with over-treat); error-prone (pay for it once, together with then pay over again to set upwardly the mistakes); together with costly (pay for to a greater extent than expensive treatments fifty-fifty though less expensive ones hit results simply every bit good). Also, or so providers “game” the organization by, for example, manipulating diagnostic together with handling codes to increment payment rates.
I assert, however, that providers are non to blame for our country's lack of focus on attention value since a “pathological mutation of capitalism” has infiltrated together with broken our healthcare system. This puts providers inward a real hard situation: Insurance reimbursement rates to hospitals together with clinicians have got been dropping. At the same time, insurance premiums consumers together with employers pay are ascension continually, resulting inward fewer insured patients, together with therefore greater non-payments from strapped patients together with increased “charity care.” On acme of that, at that spot is substantial cost for managing huge amounts of administrative paperwork (e.g., submitting insurance forms, coming together unfunded regime mandates) together with figurer information entry, non to cite enormous expense of malpractice insurance.
Under these conditions, providers have got to care for to a greater extent than patients inward same amount of fourth dimension to hold their profits, which hateful greater likelihood of errors together with omissions due to overload. And providers who move along their patients good for you lot longer through prevention, together with who care for sick patients inward the most cost-effective manner, are at serious run a jeopardy of fiscal ruin. Not to cite the lack of adept evidence-based guidelines defining what cost-effective attention genuinely is. Crazy, isn’t it?!?
Why hit I state our degree of capitalism is at source of the problem? Consider what was aired on PBS on Sept 28, 2007 on the Bill Moyers JOURNAL plan (here’s a link to the transcript). Mr. Moyers interviewed John Bogle, named past times FORTUNE mag every bit 1 of the 4 giants of the 20th century inward the investment industry, together with past times TIME mag every bit 1 of the world's 100 most powerful together with influential people. They discussed how the lack of consumer value is endemic inward America’s electrical flow degree of capitalism, together with inward particular, how our healthcare organization is adversely impacted. Following are quotes from the interview.
Mr. Moyers introduced the number this way:
In the residual of this post, together with inward subsequent posts, I volition nowadays a model for the radical transformation of our healthcare organization focused on increasing value to the patient/consumer. This model—called the “Patient-Centered Life-Cycle Value Chain”—is depicted inward the diagram below. It describes the components of a healthcare value chain from a patient-centered perspective, which promotes improve wellness together with character of life cost-effectively.
According to the diagram, 3 things are required before our healthcare organization is able to foster high-value patient-centered care:
Integration of Three Macro Processes. Integration of emergency care, sick-care together with well-care is required for caring for people inward accidents together with disasters, taking attention of people when they are ill, together with helping them avoid illness, enabling them to care chronic weather effectively to avoid complications together with premature death, together with empower consumers to brand value-based decisions.[1]
Systemic Process Reform Needs (Clinical together with Financial). Systemic procedure reform focuses on enabling providers to deliver high-value attention together with rewarding them financially when they hit so. Such reform tin move accomplished by:
---
[1] Wellness Wiki: Well-care sick-care integration
[2] The jury is silent out every bit to whether this type of universal healthcare would move improve managed past times single-payer organization (government), or if it should move left upwardly to the individual sector (insurance companies).
H5N1 high-value patient-centered healthcare organization non exclusively delivers acme character care, but it does it efficiently together with at a adept cost (i.e., cost-effectively) consistently over a person’s entire lifetime. This is real dissimilar than the healthcare organization nosotros have got today. H5N1 typical example: Greater profits larn to providers who are wasteful (over-test together with over-treat); error-prone (pay for it once, together with then pay over again to set upwardly the mistakes); together with costly (pay for to a greater extent than expensive treatments fifty-fifty though less expensive ones hit results simply every bit good). Also, or so providers “game” the organization by, for example, manipulating diagnostic together with handling codes to increment payment rates.
I assert, however, that providers are non to blame for our country's lack of focus on attention value since a “pathological mutation of capitalism” has infiltrated together with broken our healthcare system. This puts providers inward a real hard situation: Insurance reimbursement rates to hospitals together with clinicians have got been dropping. At the same time, insurance premiums consumers together with employers pay are ascension continually, resulting inward fewer insured patients, together with therefore greater non-payments from strapped patients together with increased “charity care.” On acme of that, at that spot is substantial cost for managing huge amounts of administrative paperwork (e.g., submitting insurance forms, coming together unfunded regime mandates) together with figurer information entry, non to cite enormous expense of malpractice insurance.
Under these conditions, providers have got to care for to a greater extent than patients inward same amount of fourth dimension to hold their profits, which hateful greater likelihood of errors together with omissions due to overload. And providers who move along their patients good for you lot longer through prevention, together with who care for sick patients inward the most cost-effective manner, are at serious run a jeopardy of fiscal ruin. Not to cite the lack of adept evidence-based guidelines defining what cost-effective attention genuinely is. Crazy, isn’t it?!?
Why hit I state our degree of capitalism is at source of the problem? Consider what was aired on PBS on Sept 28, 2007 on the Bill Moyers JOURNAL plan (here’s a link to the transcript). Mr. Moyers interviewed John Bogle, named past times FORTUNE mag every bit 1 of the 4 giants of the 20th century inward the investment industry, together with past times TIME mag every bit 1 of the world's 100 most powerful together with influential people. They discussed how the lack of consumer value is endemic inward America’s electrical flow degree of capitalism, together with inward particular, how our healthcare organization is adversely impacted. Following are quotes from the interview.
Mr. Moyers introduced the number this way:
Every calendar week nosotros remove heed of or so other publicly traded companionship existence bought past times a individual equity firm…What they are later is large together with quick returns on their capital. To larn it, they purchase a companionship together with cutting the wages, pensions together with wellness benefits of the employees who operate there...Thousands of nursing homes have got been bought upwardly past times individual equity firms…Profits were increased past times reducing costs, together with then investors chop-chop resold the facilities for a large profit— leaving…residents at those nursing homes worse off, on average, than they were nether previous owners.… Within months, the number of clinical registered nurses at the domicile was one-half of what it had been a twelvemonth earlier...budgets for nursing supplies, resident activities together with other services also fell... the NY Times says fifteen at Habana [nursing homes] died from what their families combat was negligent care. But when families sue, they oftentimes can't honour out fifty-fifty who owns the nursing homes because of the complex corporate structures individual equity firms have got created to encompass their tracks.Mr. Bogle said:
…it's a national disgrace. Simply put. ... we've taken …healthcare together with [gone] from making it a profession inward which the patient is the object of the game— preserving the patient "first hit no harm" every bit Hippocrates …would have got said— together with turn[ed] that into a business. And so, it's a bottom line. I've oftentimes said we're inward a bottom draw society…[but] We're criterion the incorrect bottom line.So, instead of focusing on consumer value, our society’s pathological focus is increasingly on lucre for the few past times lowering value to consumers. This maladaptive mind-set, which underlies our disturbed degree of capitalism, has infiltrated together with is undermining our healthcare organization together with tin no longer move tolerated! Changing this province of affairs requires profound transformation, together with the fourth dimension is NOW!
…There's no accountability [of these individual equity firms]. And it's wrong. It's fundamentally a blight on our society…It says something real bad nearly American society.…ultimately, the chore of capitalism is to serve the consumer. Serve the citizenry. You're allowed to brand a lucre for that. But, you've got to render adept products together with services at fair prices. …But, inward the brusk term, there's all these fiscal machinations inward which people tin larn real rich inward a real brusk menses of fourth dimension past times creating highly complex fiscal instruments [that are] non criterion upwardly to basically their duty.
…we've moved from [service to the customer before service to self] to a large upper-case missive of the alphabet accumulation — self involvement — creating wealth for the …providers of these [financial] services [and] subtracting value from society. So, it doesn't work.
What we've done is have got …a pathological mutation of capitalism from that former traditional owners' capitalism to a novel degree of capitalism, which is manager's capitalism. …corporations are run inward a real of import way to maximize the returns of its managers at the expense of its stockholders… the 5 or 6 acme officers …get enormous amounts of pay for genuinely doing real little…Real operate inward companies is done past times the people who are …doing the hard operate of making companies grow… [yet] they larn set off. …That reduces expenses. That increases earnings together with that agency the CEO gets more.
In the residual of this post, together with inward subsequent posts, I volition nowadays a model for the radical transformation of our healthcare organization focused on increasing value to the patient/consumer. This model—called the “Patient-Centered Life-Cycle Value Chain”—is depicted inward the diagram below. It describes the components of a healthcare value chain from a patient-centered perspective, which promotes improve wellness together with character of life cost-effectively.
[click icon to enlarge]
According to the diagram, 3 things are required before our healthcare organization is able to foster high-value patient-centered care:
- The integration of emergency care, sick-care together with well-care (i.e., 3 macro processes critical to cost-effective collaboration together with coordination of care)
- Changes inward how providers compete, how payments are made, together with how insurance operates (i.e., economical reform needs)
- The expanded role of novel wellness information technologies (i.e., infrastructural needs that includes placing effective determination tools inward the hands of the consumer enabling value-based decisions together with actions).
Integration of Three Macro Processes. Integration of emergency care, sick-care together with well-care is required for caring for people inward accidents together with disasters, taking attention of people when they are ill, together with helping them avoid illness, enabling them to care chronic weather effectively to avoid complications together with premature death, together with empower consumers to brand value-based decisions.[1]
Systemic Process Reform Needs (Clinical together with Financial). Systemic procedure reform focuses on enabling providers to deliver high-value attention together with rewarding them financially when they hit so. Such reform tin move accomplished by:
- Enabling providers who demonstrate improve results to gain a competitive reward for higher profits. That is, providers whose patients rest healthier longer, recover to a greater extent than quickly, together with avoid complications—and who accomplish these positive outcomes at a lower cost—would have to a greater extent than referrals, a higher payment rate, and/or other fiscal rewards.
- Providing or so degree of decent heath insurance to everyone inward our country. The insurance premiums should move based on people’s mightiness to pay together with the cost of which should move controlled through shared run a jeopardy amid large together with various populations.[2]
- Giving providers a revenue enhancement credit whenever they homecoming charity (non-reimbursed) care, on the 1 hand, together with expecting them to pay taxes on unearned income on the other (e.g., gratis trips together with other supplies provided past times pharmaceutical companies, which total $29 Billion per year)
- Demanding cost together with character transparency so that consumers together with other stakeholders know where to larn to have the highest value care.
- Focusing swell collaborative seek on edifice together with utilizing personalized exercise guidelines that define the most cost-effective treatments for detail (narrowly defined) patient types.
- Making available to patients together with providers clear information nearly how to accomplish the best outcomes safely together with efficiently, including preventive care, the role of complementary together with option medicines, together with self-management of chronic conditions.
- Assist emergency personnel together with facilities
- Support patient information exchange, noesis growth together with use, clinical determination support, coordination of care, together with management of resources (including people, medications, materials, together with facilities)
- Enable prevention, consumer decision-support together with guidance, self-maintenance, together with problem-solving.
---
[1] Wellness Wiki: Well-care sick-care integration
[2] The jury is silent out every bit to whether this type of universal healthcare would move improve managed past times single-payer organization (government), or if it should move left upwardly to the individual sector (insurance companies).
0 Response to "Healthy Living A Path To Profound Healthcare Transformation"
Post a Comment