Op-ed: Avoiding the Perfect Storm
Spiraling medical inflation coupled with poor patient care outcomes has some experts deeply concerned about the future of healthcare in America. They say a “perfect storm” is brewing, as the Baby Boom is starting to peak, an obesity epidemic is driving chronic disease through the roof and the overall health of the nation is deteriorating.
There’s more. Doctor shortages in primary care, general surgery and other key specialty areas are predicted, and Medicare cuts seem likely. And these shortages and cuts will likely take place as an additional 32 million Americans gain access to care through healthcare reform legislation.
To bring it all home, Louisiana was recently ranked 50th in the nation in overall health indicators. That’s 50th as in lowest—as in worst.
This is about as bad as it gets, right? Well, strangely enough, I’m excited about the future of healthcare in Louisiana. Why?
In an earlier column, I invited stakeholders in Louisiana healthcare to come to the table and work together to create an affordable system centered on quality. Today, I am happy to say that healthcare providers and employer groups are responding. As a result, we have begun collaborating on an innovative, new healthcare delivery system I am convinced will produce the positive results needed to reverse these dismal trends.
This new, interconnected, coordinated healthcare delivery model is known as the Patient-Centered Medical Home. Coordination of quality care in this new model brings down cost, while incentives for doctors, clinics and hospitals providing quality care and positive patient outcomes produce even more savings.
Supplied with data by a health insurance plan, a patient’s primary care physician is connected electronically to specialists, labs, diagnostic facilities and other healthcare providers, creating an environment where preventive care rarely falls through the cracks and the likelihood of duplicate tests and unnecessary treatments is greatly diminished. Also, in this transparent, data-driven model, the patient is given the information he or she needs to participate in healthcare decisions.
Beyond that, the primary care doctor is compensated through a set of incentives that reward quality care and improved outcomes, rather than a greater volume of services.
The patient in a medical home – more likely to enjoy and afford good health – is clearly the big winner. But employers who pay for a substantial portion of employee care will also benefit from this cost-effective model.
Our problem today is that we don’t have a true healthcare “system”—one in which stakeholders work together in a coordinated, collaborative manner and are truly accountable for serving the patient. And because caregivers are rewarded financially for giving more—not necessarily better—care, the services they perform cost more each year.
The medical home is the systemic approach that can change all that, creating the foundation for a coordinated care system we so sorely need.
I firmly believe that widespread adoption of this model throughout Louisiana, which is my vision and my mission, will make it possible to navigate through that perfect storm on our horizon.
But we must move fast. So, again, I am reaching out to the healthcare stakeholders in our state. As a first step, please go to www.bcbsla.com/pcmh to learn more about patient-centered medical homes and how you can get involved in this exciting new delivery model.
Mike Reitz
President & CEO
Blue Cross and Blue Shield of Louisiana
