A Disease Industry vs. A Healthcare System

[Stephen C Schimpff]

Today America does not have a true healthcare system that focuses on wellness and disease prevention. Rather it focuses on disease diagnosis and treatment paid for on a unit basis. Each visit, each procedure, each test, each drug, each hospitalization is charged for. The result is more and more units of care are given rather than a focus on how to give good preventive care and how to coordinate the care of those with complex chronic illnesses. As long as we have a disease industry – driven by our current payment system – we will have rising costs. It is inevitable because providers (and the affiliated hospitals, pharmaceutical firms, medical device manufacturers and others) will find new ways to diagnose and treat – and although these new approaches might be an improvement over what we have today it will also be much more expensive.

Eventually, as pressures mount, there will be a push for a change to a true healthcare system from the current disease-based system. This will probably take a fair length of time given that Congress did not address the payment system in the healthcare reform legislation. Basically on this point, they left it as just more of the same.

But there could be a breakthrough. Some group, some organization or some jurisdictions might create a model, gain some success and that might lead to wider adoption. Some of the large multidisciplinary “clinics” like Mayo, Geisinger, Dean and others which have contracts for “covered lives” have had success in giving more comprehensive care yet reducing costs. And some insurer/provider combined organizations – such as Kaiser-Permanente – have shown the same beneficial effects. Perhaps others will begin to adopt their examples toward better health care at lower cost.

[Stephen C Schimpff]

Thanks to the two of you for thoughtful comments. Providers definitely need to be at risk and when they are they begin to think about being cost effective while still providing good quality care - maybe even better quality care. I think that there is an interest now in the private sector to figure out some new approaches. The health care reform bill may even offer some incentives in this regard for pilot programs.

[CC-Conrad Clyburn-MedForeSight]

Stephen,

I agree with Jeff. Your analysis is point-on. What do you think are the prospects for "payment model" reform emanating from the private sector? It would seem that this would be the "catalyst" needed to truly transform healthcare delivery.

CC

[Jeff Leston]

Well spoken, particularly on the Mayo/Geisinger and Kaiser Permanente model. Perhaps, like financial reform, providers should be made to eat their own cooking and hold on to a portion of the risk, by being required to keep a reserve proportional to the premium [increases] of the people they treat. That might give them an incentive to keep us healthy