Real Healthcare System Development
by Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD
Despite all the talk about healthcare reform the only thing being talked about is insurance reform. President Obama’s speech to Congress on Sept. 9 highlighted only improvements to insurance coverage and cost reductions primarily through reductions in waste and abuse in the Medicare system.
As a practicing geriatrician, former CMS Health Policy Scholar, and associate professor at the University of the Sciences, I can tell you what is needed is real healthcare reform which involves a total change of our current delivery model.
Notice I said “current delivery” model and not “healthcare system” because for most us delivering care the thought is that we are not operating in a system. Rather, healthcare in the United States is delivered through fragmented silos focused on specialty procedures used to treat episodes of acute illnesses.
Instead what is needed is a true system of care that is built upon:
1. Integrated payment model
2. Support for a primary care focus
3. Early preventive care
Many of the elements exist in part in the health systems that are tattered as best practices such as Kaiser Permante and PACE (Program for All-inclusive Care for the Elderly).
What was probably more telling is what was not mentioned in the President’s speech. For example there was no mention to quality, improvements in access to primary care services or cost reductions focused on system improvement or factors that could really improve the health of Americans such as those that would reduce the rate of obesity.
There does appear to be some clear winners and losers in the current healthcare reform movement. Those benefiting most include:
- Those currently uninsured but moving to government subsidized insurance coverage
- Those individuals that are high risk and either insured or uninsured as the insurance reform would likely lower their premiums
- Those paying high premiums currently that move to a lower cost Public Option or Co-op.
Those likely to be made worst off from where they are today include the following:
- Those that are healthy either with or without insurance as they will be forced to pay more for coverage
- Insurance companies who would face greater regulations and decreased reimbursement
- Uninsured businesses as they would be forced to cover their employees.
- And through the Public Option providers as a result of a decrease in reimbursement. In addition because of a Public Option insurance companies would also experience a decrease in enrollment.
In the end what is needed is to focus our attention on development of a US system of healthcare that again is primary care focused and patient centered with a heavy emphasis on preventive practices such as reduction in our obesity rate. Through this type of focus we can begin to realize true and sustainable reductions in our healthcare costs, improvements in our quality of life and the ability to provide coverage for all Americans.
Dr. Richard G. Stefanacci is the executive director of the Institute for Geriatric Studies at Mayes College of Healthcare Business & Policy at University of the Sciences in Philadelphia.
When one examines the President’s speech to Congress the following points fall out:
Three basic goals:
ACCESS (COVERAGE) 1. INSURED - It will provide more security and stability to those who have health insurance.
This could be cured through simple legislation that insurance companies can’t drop someone if they complete insurance applications based on their best understanding of their health – applicants for insurance can’t lie about something of material substances but not penalized for failing to mention something insignificant Also, one should note that by forcing insurance companies to provide more coverage and cover high risk member at lower rates will result in increased payment on others in that plan.
2. UNINSURED - It will provide insurance to those who don't.
COST 3. And it will slow the growth of health care costs for our families, our businesses, and our government.