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November 3, 2015

Healthcare Reforms Aren’t Sustainable

Summary:

Despite healthcare reform under the ACA, too many healthy people will drop coverage and leave too much risk. The market must innovate.

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A recent NPR program celebrated the success of the Affordable Care Act (ACA). The benchmark was that many really sick people finally had coverage and that many poor people were now obtaining coverage because of subsidies or because of the expansion of Medicaid. If measured by participation, the healthcare reform under ACA is a success, with more growth anticipated.

Unfortunately, the long-term benchmark must be sustainability and outcomes, not participation. Government programs are often popular in the short term but not sustainable in the long term. The National Flood Insurance Program, Medicare, Medicaid, the VA, etc. will ultimately have to be “adjusted” because 100% of the taxpayers are funding these systems and a very much smaller percentage of us use them.

At some point, the non-users scream “enough already.” “Other people’s money” always runs out, and the $2.6 trillion-plus spent on healthcare is not evenly divided. 47% is spent on the sickest 5% of the population, and just 3% is spent on the healthiest 50% of Americans, according to “Healing a Broken Healthcare System,” from the Louisiana Healthcare Education Coalition. Half of the people are hardly benefiting from the money they contribute under healthcare reform.

Our systems of healthcare and healthcare financing cannot be sustained as they are trending. Yesterday’s system was not sustainable; neither is today’s ACA. The marketplace must innovate. More government and more taxes are not the answer.

Obesity and diabetes are running rampant, and too many folks (especially young people) are living a sedentary lifestyle. This lifestyle adds to the “diseased population” and the future problems and costs.

Personal and family responsibility are a necessity. Nutrition (diet) and activities (exercise) are a start. Addressing the individual in all her elements — mind, body and spirit — is a must. Answers to this crisis are inside of us as individuals and populations — not just at the doctor’s office.

Providers and institutions delivering care must leverage technology for efficiency of operations and efficacy of results. Increased availability and utilization of naturopathic physicians, physician assistants, nurse practitioners, health coaches, nutritionists, counselors and tele-medicine will ensure increased patient engagement and ultimately satisfaction and enhanced results.

Preventive medicine for all and “bringing” care and prevention to populations who can’t get to the marketplace available to most will improve lives and reduce costs. We need fewer dollars to be spent on prescriptions and invasive surgeries. It’s okay for providers and payers to just say no to demands that are not in the consumer’s best interest — regardless of what the TV commercial suggests.

Genomics, improved diagnostics to ensure earlier interventions, a focus on extending life (versus delaying death), integrated/holistic care, marrying technology and touch and technology, natural medicine and other changes are in the works now.

Other hopes rest in vascular therapy, tailored and embraced wellness plans, systems that can intervene with populations in need during crises and tailored and personalized process management for chronically ill mental health patients. Accountable care, outcome-based payment mechanisms, new models of care and care delivery and consumer engagement (personal avatars facilitating our own motivation allowing us to design our own “road to well”) are solutions now or yet to be introduced in the market of tomorrow. These are our future. Marcus Welby, M.D., is dead, but the healing and caring he delivered can live on.

This article was written in August. Last week, I received proof of the concepts. A friend received his renewal for his ACA policy. Coverage was reduced from a 70/30 co-pay (insurer pays 70%,) to a 60/40 plan, yet his premiums increased 31%. This is just the beginning — it will get worse. When you insure a majority of sick people and you subsidize many of their premiums, you will get participation. When relatively healthy and unsubsidized policyholders receive prohibitive rate increases, they will discontinue coverage, and the insured pool suffers adverse selection. Did I mention that the situation will get worse?

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About the Author

Mike Manes was branded by Jack Burke as a “Cajun Philosopher.” He self-defines as a storyteller – “a guy with some brain tissue and much more scar tissue.” His organizational and life mantra is Carpe Mañana.

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