Sometimes the grass is not always greener on the other side of the fence (in this case, the other side of the pond)
The reality of sweeping changes made with the passage of PPACA is now happening. Some will argue it’s for the better and others view the passage of PPACA as the beginning of the end to healthcare as we have known it in the USA. I personally believe the delivery system and the payment structure to support the healthcare system needed to change, however with the passage of PPACA, be careful what you wish for.
Covering 30 plus million additional people without the means to increase the structure of primary provider care, absolutely no effective rational payment methods to balance what a provider charges, and the fiduciary responsibility of the employers to manage assets of the healthcare plan … and now the added bureaucracy to implement all the provisions of PPACA as they exist today, with more bureaucracy to follow.
So what have we done? We looked at our neighbors in Canada and across the pond to the UK and said, “We should do what they do.” The grass sure seems greener over there. Is it?
I find it interesting that as the debate around healthcare reform occurred last year, many looked to the Canadian system and UK system as success on how to provide access to all and still deliver care in a cost effective way. As one of my mentors once said, “Truth over time prevails.” Just this week in a July 25th New York Times article, the headline read, “Leaders plan to turn healthcare upside down.” At first, I thought this article was another long list of articles detailing the new PPACA plan. On further review, the article announced that Britain’s healthcare system would need to be totally revamped or it would go bankrupt. Yes that’s right…bankrupt.
The British socialized program is in for major changes. The new coalition government has enacted substantial cuts in health spending. Although not all the details have been made public, what we do know there is a new focus on switching from a highly centralized control of their health system to allow the care and decisions to be made at a local level.
As mentioned in the New York Times article a document produced by the National Health Service (NHS) of the UK states, “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the NHS and putting power in the hands of patients and clinicians means we will be able to effect a radical simplification, and remove layers of management.” As the article goes on to say, “Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trust – all of which would be abolished under the plan.”
It seems as we are heading (at least in my opinion) from a highly decentralized system to one that is highly controlled at a national level. While we are moving in this direction, the British system is moving away from a highly centralize to a decentralized system.
Sometimes the grass is not always greener on the other side of the fence…in this case, the other side of the pond.
For years we have pumped a tremendous amount of money into research and design to develop innovative drugs or diagnostic equipment to identify and cure diseases. I’m not opposed to the amount of dollars invested in research and design but sometimes you wonder with all the money being invested, could simpler and less costly ideas be implemented that could be deployed to third world countries and not just developed countries?
I came across this story of two innovative Rice University undergraduate students, Lauren Theis and Lila Kerr, who were given an assignment to solve a problem. As Theis explains, “We were essentially told we need to find a way to diagnose anemia without power, without it being very costly and with a portable device."
With this in mind the two set out to find a low cost solution. They took a basic salad spinner and modified it to be able to transport centrifuge that is able separate blood and allow the accurate diagnosis of anemia. This is done without using any electricity.
As shared in the news article, "In rural, under-served and impoverished parts of the world, a positive diagnosis for anemia is a critically important clue when looking for other health problems such as malnutrition, or serious chronic infectious diseases such as malaria and HIV/AIDS. Until now, blood samples taken in the field would have to be sent to a distant location complete with expensive laboratory centrifuges and electricity, while patients would be left waiting for the results — a lapse in time that can be deadly. Being able to diagnose the condition in real time with "Sally Centrifuge" would allow appropriate treatment to begin before an illness progresses and a patient's condition deteriorates too drastically”
What can a salad spinner teach us about healthcare costs? Sometimes the most effective and easily affordable solution has already been developed … just not for healthcare per se.
Photo Credit: Jeff Fitlow/Rice University
I have written the past about the slow adoption rate for innovative technology and solutions in the healthcare payer space. Not much has changed in the way healthcare payers interact with healthcare providers. This will change and it must change. We are starting to see some signs of the “paralysis by analysis” walls are starting to crumble in healthcare. It is an evolutionary process and yet outside the healthcare payer space we see a technology revolution occurring.
For example, today I read in the Wall Street Journal that Amazon announced E-book sales outpaced hardcover sales. A few years ago no one thought it possible and yet it just happened. The ease and convenience of reading a book just got easier. Oh I forgot to mention that Amazon reduced their rate of the Kindle device and of course e-books are cheaper. We don’t see a reduction in healthcare charges whenever new technology is applied. In fact, prices traditionally go up.
If healthcare payers and providers are going to remain an integral part of the future landscape of healthcare delivery they must adopt technology that will continually improve outcomes while reducing the charges for services. Today the providers are still asking for things to be faxed, forms filled out on paper and photocopied, doctors who still handwrite prescriptions that nobody can read.
iphone, ipad, Kindle, Fax…(oops). So long fax. The “paralysis from analysis” wall is about to tumble.
In the July issue of Managed Healthcare Executive there was an interview with Karen Davis, President of the Commonwealth Fund, a private foundation based in New York that supports research on improvements in healthcare. In this interview I was struck by her comments relating to payment innovations. She is quoted in this article “But the bigger issue is whether the public and private sector can work together on payment…Some states may be willing to use their convening skills to bring different parties together to identify a payment model that is more rational instead of having so many different ways of paying. It’s consuming so much in administrative costs.”
I wholeheartedly agree with her assessment. With the recent passage of PPACA all eyes are focused on providing access to 32 million uninsured/underinsured people. However, there has been no attention to developing a rational payment approach to support this added burden on states and individual employers. For years, we have operated on a payment methodology created by Medicare which today is broken, or a system based on contracts based on discounts in return for volume that is no longer advantageous to employers. What do we do? Our current system is not sustainable. Anyone in the business realizes this and we need to change this quickly.
A rational payment process is needed and will be central to the success of a sustainable healthcare system. Since 2001 we have worked on ways to bring rationality to an irrational payment world. The spotlight of the sustainability of healthcare will be squarely on this word “rational reimbursement.”