Saturday, September 15, 2007

Pass the Mayo

Mayo Clinic believes America's health care system urgently needs reform to ensure the future of quality patient care.

Reform? What kind of reform?

universal insurance coverage, coordinated care, value and payment reform.

OK, let's see what they propose.

Keep in mind, the Mayo clinic is the supply side of the economic equation. They don't have to worry about how to fund the changes.

Provide health insurance and access to basic health care for all Americans -- regardless of their ability to pay.

Health insurance (and basic care) regardless of ability to pay. How do they propose this will be handled?

Move from employer-based insurance to portable, individual-based coverage. Employers could still help finance a portion of their workers' health care expenses and should be encouraged to promote employee wellness.

Portable individual insurance. I'm all for it.

Employers can finance a portion of the cost. Of course we all know that employers don't finance anything.

Employee wellness has been tried for years with almost no success. More recently employers have switched from the carrot to the stick and are now getting the attention of their workers. When smokers, those who are obese or have preventable medical conditions (HTN and Type II diabetes for example) are charged extra premiums, only then are lifestyle changes implemented.

Create a simple mechanism (similar to the Federal Employees Health Benefit Plan) to offer private insurance packages to buyers.

The Federal Employees Health Benefit Plan is a self funded MEWA. Will someone tell me what this plan does to control health care inflation?

Require individual ownership of health insurance, with sliding-scale subsidies for people with lower incomes.

Low income people already have access to free or subsidized care.

Appoint an independent health board (similar to the Federal Reserve) to define essential health care services. Allow people to purchase more services or insurance, if desired.

Why do we need a governmental body to define "essential health care"? Is the general population really that ignorant?

Patient care services must be coordinated across people, functions, activities,
sites and time in order to increase value. Patients must be active participants
in this process.

Coordinated patient care. I believe case managers already do this.

Realign the health system toward improving health rather than treating disease.

Nice idea, and it can be handled with more free or sliding scale clinics (such as Minute Clinic).

This is well and good, but until we find a way to tame the XXL generation all the clinics in the world are not going to do much good.

Increase quality and patient satisfaction. Decrease medical errors, costs
and waste.

This sounds more like fluff than anything.

Reward consumers for choosing high-quality health plans and providers

Rewards? You mean like air miles and trips to exotic places?

Consumers have access to more information than ever before on health care and ways to finance the cost of their care. Yet they are overwhelmingly lazy in taking advantage of information that is literally at their finger tips.

We have a society of quick-fixes. Instant food from package to microwave to table in under 5 minutes. Instant cash from an ATM 24/7. We demand quick results from our health care providers in the form of a pill and shy away from lifestyle changes that could be much more beneficial than introducing more chemicals into our bodies.

Change the way providers are paid in order to improve health and minimize waste

As in an all cash system like we once had?

Design payment systems to provide patients with no less than the care they need and no more than fully informed, cost-conscious patients would want.

That would be cash.

Pay providers based on value.

Cash again.

Further develop and test models of payment based on chronic care coordination, shared decision-making and mini-capitation (i.e., one bundled fee for the physicians and hospital delivering acute care).

Capitated fee structures already exist for many routine procedures such as normal delivery. I doubt it will work that well on chronic situations.

"Well Mr. Jones, it seems you have hit your limit on insulin for this month. Come back in two weeks when the new month begins and we will start you up again."

Yeah, that works.
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