In the September 2019 journal of the Amercian Medical Association, a group of researchers for Humana published the findings of a multiyear study putting the spotlight on the nearly 25% of our country’s annual total health-care spending that can be deemed as waste, or between $760 billion and $935 billion each year. It would appear that $1 out of every $4 spent on healthcare in the U.S. annually is being wasted.
If neither the fee for service nor the managed care model have been able to contain the ever rising cost of delivering health care to the American people and with the political talking point of free health care for all, and the estimated projected costs approaching almost the full revenue stream coming into the government–something’s gotta give.
Value-Based Health Care
Some are suggesting an approach called value-based healthcare may have some positive effects on reducing costs as well as quality of healthcare we are all hoping for.
According to an article found at https://catalyst.nejm.org/what-is-value-based-healthcare/ value based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way. This approach differs from fee-for-service and managed care where providers are paid based on the amount of healthcare services they deliver. The “value” in value-based healthcare is derived from measuring health outcomes against the cost of delivering the outcomes.
This approach holds out the hope that chronic diseases and conditions like high blood pressure, obesity, cancer, diabetes, COPD, etc. can be managed more efficiently and effectively by taking a more coordinated approach to their treatment.
Patient-Centered Medical Home (PCMH)
The article referred to above identifies this coordinated approach to healthcare as a patient-centered medical home (PCMH) where the patient’s primary physician coordinates primary, specialty, and acute care. It is referenced as a home but it simply means everything about the client is stored in one place rather than in multiple venues. This gets rid of redundant testing, increases sharing of medical records, provides better access to medical procedures being required, eliminates the need for second opinions, requires fewer hours spent in the doctor’s office by patients due to use of electronics and communication devices to share information. “The goal of electronic medical records sharing is to put crucial patient information at each provider’s fingertips, allowing individual providers to see results of tests and procedures performed by other clinicians on the team. This data sharing has the potential to reduce redundant care and associated costs.” (Ibid.)
As this delivery system is incorporated, the providers will have their work cut out for them. The buying public has such a mindset of running to the doctor for every miniscule ache or pain, that a reeducation campaign will need to convince the public some things are just not meant to be attended to by a medical professional. Some aches and pains can be dealt with by some personal attention to lifestyle and procedures.
On the other end of this value-based delivery system is the old obsolete entrenched fee-for-service and managed care system which has been richly rewarded by existing procedures. Is there sufficient motivation to turn the ship around? Is it fair to say, most providers of medical assistance are in it for the profit they can make not the services they provide which make people better? Is it also a fair observation that the further away from the recipient of service rendered are being paid, the less interest in making changes? For example, if I go to the doctor and have to pay immediately for service rendered, I think twice before going; whereas if I can go to the doctor and give them a card authorizing them to bill an insurance company far away, I don’t really take the time or interest in knowing what the actual cost is going to be. After all, it is a great big insurance company and they can afford it.
As one contemplates the methods for healthcare delivery, it makes one wonder if in attempting to change to value-based healthcare system isn’t it just kicking the proverbial can down the road? Who really wants to tackle such a monster? Also, look at the mess we are in with Affordable Care Act (ACA.)
Can anyone say we have found a way to make our healthcare system provide the level of service we desire while making it affordable to all? It’s going to take a whole lot more constructive work for this to happen.
Christian Healthcare Expense Sharing
In the meantime, perhaps a little light shining on the horizon may have a partial answer in our quest to deliver healthcare efficiently and effectively.
While the nation struggles with healthcare spending, a group of Christian faith adherents have since 1993 been associating themselves with the concept of pooling their resources to attend to the medical expenses of their members in non-profit organizations i.e. Liberty, Medi-Share, Christian Care Ministry. These non-profit alternatives to the traditional health care insurance industry are designed to allow members to pool their resources and share the medical expenses of other members. Being non-profit organizations, they are able to offer coverage for up to 60% less than traditional plans which look upon clients as a way to generate a cash flow, allowing them to collect a premium and then invest it. They are incentivized to take in as much as possible and pay out as little as possible. Also, because they are looked upon as not being health insurance per se, the monthly payment is not tax deductible like a Blue Cross or Blue Shield plan.
The concept is quite simple as reported in www.medisharereviews.com/
“When you join Medi-Share, you select your desired Annual Household Portion (AHP) which works like a deductible does for traditional insurance. You then make monthly payments based upon your marital status, age, and the desired AHP.
The process for seeing a doctor or specialist and getting them paid is
- Go to your current healthcare provider;
- Or do an online search for doctors in Med-Share’s substantial PHCS network;
- Choose your preferred nearby doctor or specialist;
- Show the doctor’s office your Medi-Share Member’s card;
- Pay the $35 Copay;
- They submit the bill directly to Medi-Share.
So long as you’ve paid more than your AHP, Medi-Share pays the bill for you using the monthly shares of other members. If you haven’t reached your AHP, then they negotiate the best discount they can and you are mailed a bill for the rest. Also, it must be noted, the payment provider’s ability to pay for expenses is contingent upon adequate member payments being received. Each member is responsible for their own expenses; and if provider does not have sufficient funds, each must bear the burden associated with the lack of funds.
A unique difference between this model of healthcare delivery and fee-for-service or managed care is it was designed to provide services only to members who espouse a Christian lifestyle. Any medical expenses going against a Christian way of life aren’t covered such as drug abuse recovery, getting into a car accident with alcohol in your blood, or getting an abortion. In addition to those exemptions, when enrolling you agree to no smoking, reasonable abstinence from alcohol, maintain a healthy weight and blood pressure. You will not be quizzed on Bible knowledge or be required to prove church attendance. These plans work largely because it is a community of like-minded members with strong Christian values.
Since these plans have been around prior to the requirement that everyone must enroll in health insurance plan or be fined, they have been grandfathered and meet the requirements imposed by ACA.
These plans are experiencing incredibly fast growth due to the confusion in the marketplace caused by ACA and the ou- of-control premium growth. These plans are attractive especially to those who want to have some control over what services are provided and what they are being charged for services provided. They are also attractive to those who have a feeling of wanting to help people of like religious attitudes.
It would be fair to say, the jury is still out on whether these plans can gain sufficient momentum to get them through this health care delivery system dilemma or if they will fall victim to some governmental plan or pressure from traditional health care delivery systems. Time will tell.