Evolution of US healthcare system: Part V

In our last installment of this series, I’d like to review some of the ongoing changes in our healthcare system and their potential impact on how healthcare is practiced in US.

First, health insurance exchanges are meant to provide everyone an opportunity to have health insurance. On the surface, this might suggest increased costs to the government since many people will receive government subsidies to buy health insurance. How, then, does this help the government save money and stay solvent? Well, many of these people are currently getting care in very expensive settings such as emergency departments or hospitals, and cost the system lots of money. This results in rise of the healthcare costs and everyone ends up paying more, including the government. By insuring everyone, the goal is that people will get preventive care and have access to the system before they need to go into the emergency departments or hospitals. This will result in lowering the overall cost of care. The Congressional Budget Office (CBO) projects that this will result in significant reductions in overall healthcare costs over the next few decades.

Second, payment reform will mean that providers will need to shift from getting paid per episode of care to payment based on the outcome of their actions. This is quite a change from how medicine has been practiced and paid for historically. Providers are used to seeing their patients when those patients feel that they need medical care. After each episode of care, be it in a clinic or in a hospital, patients and their families are responsible for following the medical instructions. Now, with the new payment models, providers need to worry whether their patients will fill their prescriptions or take them. They’ll need to identify their high-risk patients, anticipate their complications, and intervene before they reach a critical stage where they may need expensive care in a hospital. How are providers dealing with this? Many are taking very measured steps toward these new care delivery models. Change is not easy but you have to start somewhere.

Let’s next talk about what providers are doing to succeed in this new world.