The health care reform effort has been hampered by a lack of clarity and the pursuit of the wrong goal. We need a new, more focused approach to health care that puts the interests of patients first. The traditional approach to delivering care hasn’t worked, and the current payment structures aren’t aligned with improving value. Instead, we need an approach that focuses on increasing patient outcomes and improving efficiency and cost.
One way to improve the efficiency of health care is to focus on preventing diseases and increasing preventive services. This could reduce future high-cost health care spending on preventable diseases. Another way to lower health care costs is to focus on environmental and societal factors that can affect health. A lack of measuring the value of health care can contribute to wasteful spending.
In addition to focusing on outcomes, health care providers should also measure processes and costs. They should also meet regularly to discuss patients and discuss the results of their care. These teams must accept joint accountability for their actions and results. Only then can they improve health care. The health care industry will benefit from this effort. In the long run, more people will be healthier and will enjoy better quality of life.
In the past, providers demanded higher payment rates from commercial health insurance plans in order to make up for Medicaid and Medicare losses. In many cases, providers gained eight to ten percent increases annually. Today, however, health care providers are under increasing pressure to control costs and provide health care for more people. This includes engaging in price negotiations, raising deductibles, and expanding health systems and “narrowed networks” products that direct patients to lower-rate providers.
The healthcare ecosystem is a complex system comprised of many different industries, products, and services. It is vital to choose the right mix of these. When patients have the freedom to choose the goods and services they need, they become smart consumers. Competition brings down prices and improves quality. In the long run, the health care ecosystem will evolve as the needs of patients evolve.
Health care organizations need to measure the cost of care and how it relates to outcomes. Currently, most cost-accounting systems only give crude estimates for individual services. Without a reliable cost-management system, clinicians and administrators don’t work together to improve the quality and value of care. This is why accurate, actionable cost data is critical for the improvement of health care.
The Affordable Care Act (ACA) increased Medicaid eligibility with federal subsidies, and created premium subsidies for private health insurance in the marketplace. Medicaid is funded by a combination of state and federal tax revenues. In most states, the federal government funds Medicaid expansion through matching grants, but the federal share has decreased over time.