One of health care’s most corrosive myths is that nothing can be done about exorbitant cost. But there are alternatives, if they can make their way into the marketplace.
The health care policy arena has become a tug-of-war between ideologues and special interests, and offers few solutions. So far, neither group appears interested in addressing the deep overtreatment and pricing issues that drive the cost crisis.
With influence bought by the health care lobby, the health care marketplace is also largely controlled by large corporations - insurance companies, hospital systems, drug and device companies. These groups have devised mechanisms to make health care cost as much as possible, producing good-to-mediocre health outcomes at double the price paid in other industrialized countries. From this perspective, Americans now receive the lowest health care value in the world. Health care’s unrelenting, breathtaking cost has become the biggest threat to our national economic stability.
There are ways to effectively manage care and cost, especially in the market. Decades of fee-for-service reimbursement, which pays for services independent of results, have so bloated nearly every part of our system that health care’s excesses are bubbles waiting to burst. There’s reason to believe that this change is about to happen.
In many high cost niches of health care, there are innovative, evidence-driven companies that, have rethought health care problems and developed entirely different solutions than conventional care. These firms deliver far better health outcomes at dramatically lower cost.
Consider, for example, a Florida-based musculoskeletal (MSK) management firm, that now has Fortune 500 clients. Its processes allow its clinicians to intervene on 80 percent of MSK cases. After 100,000 patient encounters, independently reviewed data clearly show better pain reduction, range of motion and Activities of Daily Living, in half the recovery time and half the cost of conventional orthopedics. They’re so confident about their capabilities that they’ll financially guarantee a 25 percent reduction in MSK costs. MSK disorders represent 20-25 percent of group health costs and 60 percent of occupational health costs, so a company that moves to this approach will see its total health care spend drop by 5-13 percent, an enormous sum.
We have found similar impacts available in management of cardiometabolic conditions, cancer, dialysis, imaging, drugs, claims reviews, and many other areas.
Not surprisingly, most insurance companies haven’t been receptive to these approaches. In general, health plans make a percentage of total health care spend and so want it to be higher. Mechanisms that disrupt the status quo and drive down cost aren’t necessarily in their interests.
These programs are becoming readily available around the country. Larger employers -- those with 100 or more employees -- can choose programs that are most likely to fit their businesses, and watch their costs plummet. Soon, new health plans will emerge, bringing together these management “modules” under a single umbrella, and offering health plans with better results at lower cost.
This is coming. As it does, everything in American health care will begin to improve.
I am so excited to speak at the 2017 HealthCare Forum Conference on Nov. 16 at the Best Western Premier Helena Great Northern Hotel , which is hosted by the Montana Chamber of Commerce. I will give a keynote address at 2:45 p.m. called “Speak Up! How Utilization Matters.” There are other panels and speakers including state legislators and Insurance Commissioner Matt Rosendale.
To register, visit wwww.montanachamber.com/events/montana-healthcare-forum. I hope to see you in Helena!