Bringing about positive changes into the US healthcare system

[Roger Steven]

The American healthcare industry is a curious mélange. On the one hand, it is the world’s largest industry, with an estimated size of around $ three trillion. It is a system in which any treatment option that one can think of is available to the patient. Yet, it is characterized by a high degree of inefficiency and exorbitant costs. Many treatment options are out of reach of a large number of patients. It also suffers from non-implementation of many best practices that would have ensured a much better outcome for patients.

If the quality of care was proportionate to the size of the industry; the US healthcare industry should have been the world’s biggest not just in terms of the market size, but also in terms of quality. Quality is the core ingredient that is missing from the US healthcare industry. It fares poorly in comparison to even much less developed countries in the region, such as Cuba. As a result, the US healthcare industry is in a situation today where there is total mismatch between the high cost of healthcare and the quality of outcomes.

Rays of hope

There is hope, though. Two recent trends have aroused interest and promise that this scenario could change:

• The increasing shift by payers from traditional volume-based payment models to value-based payment models that reward efficiency and high quality
• The growing interest in translational science in transforming new research findings into improved practice, of which precision medicine is a notable example.

Adapting these and implementing them into a healthcare practice offers enormous scope for improvement of the system, but is not without its challenges. Healthcare providers need to show flexibility and gumption to come out of their traditional payment models, to which they have been accustomed for too long.

Explanation of these trends at a learning session

This interesting and highly useful topic will be discussed at length at a very interesting and interactive webinar that is being organized by MentorHealth, a leading provider of professional trainings for the healthcare industry. Dr. Maggie Gunter, Director of Medical Outcomes Research, Albuquerque, NM, who is an experienced and respected health services researcher and medical sociologist who was among the early innovators in disease management, case management, and use of data to evaluate and improve care and measure population health, will be the speaker at this webinar.

To hear Dr. Gunter’s insights into how a few techniques can go a long way in helping to transform the US healthcare industry, please register for this webinar

Good healthcare need not be expensive

Dr. Gunter will seek to destroy the myth that implementing high quality healthcare has to necessarily be expensive. She will explain key tools, techniques, and approaches that have been shown to be effective in helping providers improve care quality, outcomes, patient satisfaction and engagement, and also reduce costs. She will discuss a few successful models that have proved effective in different delivery settings and in bringing about behavior change for different target populations.

These models and techniques will serve as an important standpoint from which healthcare providers can make the difficult change from one reimbursement pattern to another. The ways in which they can be trained and assisted in these techniques will also be taken up, along with what roles major stakeholder groups, notably patients and consumers, play in identifying innovative solutions and hastening this transformation.

Addressing concerns from healthcare professionals

She will address concerns among many professionals in the healthcare industry about how to transition to the new payment system and lower costs to meet the emerging new goals of both federal and private payers and ways of complying with the new MACRA regulations that CMS is promulgating.

Dr. Gunter will take up the following areas at this session:

• Description of the current transformation of American medicine, including the current transition of U.S. health system reimbursement from traditional fee-for-service reimbursement to value-based reimbursement and the growth of translational science to enhance the spread of evidence-based practice
• What are the factors driving this change and how should providers and other stakeholders respond? (e.g., enormous variations in care outcomes, and costs across the nation, representing clear opportunities for improvement)
• Examples of health systems and programs which serve as successful models of high-quality, lower-cost care and the techniques they use to achieve these results (e.g., integrated systems, Project ECHO)
• Key factors in successful implementation in different healthcare settings and how the context influences the appropriate approaches
• Key steps in evidence-based practice
• Organizations available to help with training and quality improvement techniques at low or reasonable cost in response to the MACRA initiative from CMS (e.g., the regional CMS Quality Improvement Organizations).