OP-ED

Op-Ed: Health Care Re-invention and Personal Responsibility More Critical to Reform than Government Intervention

Stephen Kardos

President Obama should be commended for addressing the challenge that’s facing our nation’s health care system. While Democrats and Republicans agree that the health system is broken (since 1975, per person annual health spending has grown 2.1 percent faster than overall economic growth per person¹), there is no clear agreement on the next steps that need to be taken to fix the problem.

President Obama has offered the idea of implementing a national health care plan; however, in its current iteration, his plan doesn’t address what’s broken with the system. Instead of flooding the system with 46 million more insured persons and spending $1.2 trillion over the decade, Obama should look to the hard evidence that indicates a third of all health dollars currently spent each year (more than $750 billion) are wasted. That lump sum should be brought back into the system to care for the uninsured and reduce the national deficit at the same time.

To reclaim those lost dollars, we need to evaluate the emerging value-based health care space.

For background, value-based health care plans have three components:

  1. A special plan design that rewards high quality care by patients and their physicians
  2. A system for information exchange such as an interactive personal health record that highlights exactly for each person (and their physician) what their recommended care actions are and what is missing! and
  3. Decreased premium for patients and better payment for physicians and hospitals.

For physicians and patients who participate in value-based health plans, each person must comply with CDC guidelines for disease prevention and management. For example, diabetic patients not only need care for diabetes, but also for early cancer identification and immunizations to prevent infectious diseases. Each individual and their physicians have online access to a personal health record that enumerates gaps in compliance with care. Using this tool – which is available today – patients essentially have a to-do list that helps them close the gap.

For the example above to work, we must recognize that health, like democracy, requires active participation of all our country’s citizens. Our government does not work when we fail to vote. Likewise, our health system cannot work if we fail to actively participate in taking care of ourselves.

And while legislation is one important way to change behavior – e.g., the motorcycle helmet and “Click it or Ticket” laws are two successful examples –we must also educate and incent payers and payees into participating voluntarily. We need both carrots and sticks for success.

The paradox is that in value-based plans, people see their doctor more frequently while overall medical expense decreases (and overall health increases). With this ounce of prevention, individuals can be made aware of potential medical problems before they become life-threatening. Imagine if your doctor said, “At the rate your blood sugar is rising, you will more than likely contract full-blown diabetes in the next year.”

As such, part of any value-based reform campaign must involve education that reminds people how many Americans (with or without insurance) face bankruptcy because of preventable health catastrophes. In short, we must put in real terms how much money Americans will save by staying healthy using value-based plans.

Like “click it or ticket,” just by following the rules of the road for health and using available technology, each person and their physician can recover one-third of a trillion dollars a year for America starting today. That’s reform we can believe in.

—————

1) Council of Economic Adviser’s Executive Summary, “The Economic Case for Health Care Reform,” June 2009.  http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf

Dr. Kardos is the former Chief Medical Officer for Horizon Blue Cross and recent past Chairman of the Board of AT Still University. He founded Triveris 18 years ago to reduce health costs by improving medical care quality using information exchange and low cost available technology. He is a fellow of the American Academy of Pediatrics.

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JanSImpsonAshish KachruReggie Greene / The LogisticianPsychologyDr. Rick Lippin Recent comment authors
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JanSImpson
Guest
JanSImpson

What is this a love-in for healthcare reform that has no chance of reform. So let’s just take a look at just a few items – 1. America’s healthcare costs are skyrocketing because a. malpractice insurance 2. attorneys and their suing habits c. we pay for the high costs of drug and medical device research costs which is considered “commoditized” by the time it reaches the international community – so quit lying to Americans

Ashish Kachru
Guest

I agree that to take the extra and unnecessary cost out of the system we need a complete payment reform. The current system does not reward either the physician or the patient to do the right thing. Today we widely agree that a value based health plan should provide incentive to the patient for adopting healthy behaviors but we equally need to reward the physician for providing the appropriate level of care according to evidence based guidelines. Obviously any intelligent tools that guide the physician and patient according to those evidence based guidelines and identify gaps in care will be… Read more »

Reggie Greene / The Logistician
Guest

We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.

Psychology
Guest

Thank you Dr. Kardos .

Dr. Rick Lippin
Guest

Thanks Dr Kardos
I believe that we must apply the same boldness and creativity to health care as we are to the energy and environmental crises.
We need to challenge our fundamental assumptions under which we have been operating.
Nothing less will carry the day.
But a $2.5 trillin dollar culturally embedded scam is really hard to change
Dr. Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

MD as HELL
Guest
MD as HELL

Tort reform first. Only then can primary care have the cover to tell patients “no”. This is one of the only two ways to cut system costs. The other way is to make the patient pay for “nice but not necessary” care. People always want care that they do not pay for. When we opened our urgent care in 1998 we would have the patient pay for the entire visit and then collect from their insurance company. At the time it was a business model that was not flying. After a year we started billing insurance and we are, of… Read more »

HIT insider
Guest
HIT insider

complexity is the enemy of the truth

Margalit Gur-Arie
Guest

This is all true in theory. People should take better care of themselves and they should be encouraged to do so. Encouraged is different than forced. Reality being what it is, some people will not. Just like some people will not vote, but democracy does not collapse on account of that. We cannot build a theoretical system based on the assumption that everybody will be “compliant”. I do agree with the notion that primary care physicians are key in any health care reform. The problem is that as long as the reimbursement system is not tilted in favor of primary… Read more »

Wendell Murray
Guest

“it’s very important for people to realize that some physicians are critical to improvement.” Prof. Victor Fuchs wrote years ago in one of his books that the physician (mainly the primary care physician) is the key figure in all matters related to healthcare including cost control, because they are at the key decision-point on treatment and have the authority and knowledge to make make final decisions on behalf of a patient (and with the patient). No question that were primary care physicians more or less united on basic principles and role that they could see to both improvement in care… Read more »

Lori
Guest
Lori

clearly changes must be made. The bigger question is, what will they be?

Deborah Calvert
Guest
Deborah Calvert

Sun Healthcare’s former Sunbridge skilled nursing facility in Newport Beach, Calif, caused my mother months of great suffering which eventually killed her one year after they refused to repair / replace known broken equipment while under a Calif state injunction for having killed patients in Burlingame, Calif years earlier. I have written documents proving top management knew one year before that their equipment was inoperable yet they did nothing to respond to a critical situation which was a blatant disregard for human life otherwise known as wilful misconduct by CEO’s leaders. This made me eligible for treble damages (triple the… Read more »

Deborah Calvert
Guest
Deborah Calvert

Here’s some wasted monies we should be able to recover from the nursing homes like Sun Heatlhcare Group Inc.: Potentially inappropriate nursing home payments spur increased Medicare Part A, Part D oversight June 08, 2009 Tens of millions of dollars were likely inappropriately paid to skilled nursing facilities through the Medicare Part D prescription drug program in 2006, according to a recently released report from the Department of Health and Human Services Office of the Inspector General. According to the OIG report, Part D spent roughly $41 million that year to pay for drugs for nursing home residents who should… Read more »

Deron S.
Guest

The end of the fee for service payment model will be a sad day because it will be another symbol of how greed and ignorance won again. In a perfect world, the FFS model would be clearly superior because more work should mean more pay if the physician is pure-intentioned and the patient is compliant and empowered in his/her role. Unfortunately, I think we all know that our society is a little less than perfect. Sadly, we will address the problem with payment reform but never address the greed and ignorance problems. I thought for a second this was deja… Read more »

Biotech Analyst
Guest
Biotech Analyst

To add to Dr. Esslinger’s point, that $750 million isn’t actually waste, that is money in someone’s (i.e., doctor or hospital) pocket. Reallocating that money to preventive care is the right thing to do, but you can bet you will be hearing plenty of anguished screams from specialists and hospitals about that. They aren’t going down without a fight.

Carla Kakutani MD
Guest

Agree fully that not much being discussed right now on healthcare reform really addresses the need to change benefit structures and physician/hospital payment incentives so we can have every part of the system pulling in the same direction. The patient centered medical home, as in Sherry Reynold’s link, could be a key foundation to build upon, if only we could get away from the tyranny of fee-for-service. I hold out hope that the “public option”, which theoretically would have the freedom to build in a new payment and benefits methodology, would take advantage and harness these ideas.